Risk Assessment for Severe Postoperative Hypocalcaemia after Neck Exploration for Primary Hyperparathyroidism

Kald, B; Heath, David; Lausen, Iver; Mollerup, Charlotte

doi:10.1177/145749690509400308

Cited by 24 publications

(39 citation statements)

References 18 publications

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“…Our study similar to Kald et al [9] showed statistically significant correlation between pre-operative serum PTH and fall in post operative calcium causing POH. Going by the mean PTH values in the three groups, one could surmise that patients whose pre operative serum PTH levels was, in general, below 500 pg/mL would be asymptomatic post-operatively with calcium levels well within normal range and could be discharged immediately, provided they did not suffer severe bone symptoms pre-operatively.…”

Section: Discussionsupporting

confidence: 91%

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Parathyroid Hormone as a Marker for Predicting the Severity of Hypocalcaemia Following Parathyroidectomy

Sekhar

Nayak

Suhasini

et al. 2015

Indian J Otolaryngol Head Neck Surg

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The purpose of this study is to determine preoperative predictors of the severity of the hypocalcaemia following parathyroidectomy. The case records of 70 patients who underwent parathyroidectomy for primary hyperparathyroidism from 2000 to 2013 was retrospectively studied. Their symptoms at presentation, biochemical parameters serum calcium, parathyroid hormone, alkaline phosphatase and parathyroid size on ultrasound were compared with their serial post-operative serum calcium levels at 24, 48, 72 and 96 h. For the purpose of analysis, patients were divided into three groups. Group 1-asymptomatic, biochemically normal (serum calcium always C8.5 mgs%); Group 2-asymptomatic, biochemically below normal (at least one reading \8.5, but none \8.0); Group 3-symptomatic (any one reading\8.0). No correlation was found between the severity of the presenting symptoms, pre-operative serum calcium levels or the parathyroid size with the post-operative calcium levels in the three groups. Though preoperative serum alkaline phosphatase levels were higher in Group 3, it was not statistically significant (p = 0.069). However, preoperative serum parathyroid hormone levels significantly correlated with postoperative serum calcium levels in all three groups (p = 0.006). Pre-operative serum parathyroid hormone levels may serve as a marker for severe post-operative hypocalcaemia and thus identify patients requiring closer monitoring and longer hospitalization following parathyroidectomy.

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Section: Discussionsupporting

confidence: 91%

“…Correlation between serum PTH and adenoma weight has been studied by several authors [7][8][9][10][11][12][13][14], as well as serum calcium and adenoma weight [7]. However, results from different studies have been variable.…”

Section: Discussionmentioning

confidence: 99%

Parathyroid Hormone as a Marker for Predicting the Severity of Hypocalcaemia Following Parathyroidectomy

Sekhar

Nayak

Suhasini

et al. 2015

Indian J Otolaryngol Head Neck Surg

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“…Airway obstruction and recurrent nerve damage are rare. Postoperative hypocalcemia is the only reason that physicians keep patients in the hospital for more than 24 hours after surgery (3). The purpose of this study is to establish the predictive factors in patients who develop postoperative hypocalcemia and HBS after they undergo parathyroidectomy for primary hyperparathyroidism.…”

Section: Introductionmentioning

confidence: 99%

“…It is associated with excision or biopsy of more than two parathyroid glands, accompanying thyroid surgery, history of previous neck surgery, inadvertent gland removal, hemodilution, temporary vascular compromise of the remaining parathyroid tissue, and long-term hypocalcemia suppression of non-adenomatous parathyroid tissue (3,9,10). One of the reasons for postoperative hypercalcemic is hungry bone syndrome (HBS).…”

Section: Introductionmentioning

confidence: 99%

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Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

Kaya

Tam

Dirikoç

et al. 2016

Arch. Endocrinol. Metab.

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Objective: Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and it may extend hospitalization durations. The purpose of this study is to determine the predictive factors related to the development of hypocalcemia and hungry bone syndrome (HBS) in patients who underwent parathyroidectomy for PHP. Materials and methods: Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD, albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1 st and 4 th days postoperatively, and in the 6 th postoperative month, and their neck ultrasound (US) and bone densitometry data were also recorded. Results: Hypocalcemia was seen in 63 patients (38.4%) on the 1 st day after parathyroidectomy. Ten patients (6.1%) had permanent hypocalcemia in the 6 th month after surgery. Out of the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP, and BUN values were higher in those patients who developed HBS. Furthermore, HBS was more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who underwent thyroidectomy simultaneously with parathyroidectomy. Conclusions: As a result, patients who have the risk factors for development of hypocalcemia and HBS should be monitored more attentively during the perioperative period. Arch Endocrinol Metab.2016;60(5):

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Pre-operative and post-operative concerns in the management of patients undergoing parathyroidectomy

Mazzaglia

Berber

2007

Clinic Rev Bone Miner Metab

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Hyperparathyroidism and associated hypercalcemia have multiple diverse end-organ effects. While most patients will not present with acute symptoms of hypercalcemic crisis, practitioners must take the necessary steps to ensure maintenance of safe serum calcium levels prior to surgical cure. The management of post-operative hypocalcemia likewise requires diligence and knowledge of treatment options. Increasingly, vitamin D is being appreciated as an important component of treatment, particularly in those with insufficient vitamin D levels. Awareness of the pre-and post-operative problems which can affect patients with HPT is useful for all physicians in order to ensure optimal care of patients with hyperparathyroidism.

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Risk Assessment for Severe Postoperative Hypocalcaemia after Neck Exploration for Primary Hyperparathyroidism

Abstract: Background and Aims:A further development of the risk profile for severe postoperative hypocalcaemia after surgery for primary hyperparathyroidism (pHPT) was made with the aim of expanding the group of patients who can be discharged safely after 23 hours.Methods

Cited by 24 publications

References 18 publications

Parathyroid Hormone as a Marker for Predicting the Severity of Hypocalcaemia Following Parathyroidectomy

Parathyroid Hormone as a Marker for Predicting the Severity of Hypocalcaemia Following Parathyroidectomy

Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

Pre-operative and post-operative concerns in the management of patients undergoing parathyroidectomy

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