Persistent elevation of parathormone levels after surgery for primary hyperparathyroidism

Background: Persistent elevation of serum parathyroid hormone (PTH) despite normocalcemia have been documented in 8- 40% of patients after parathyroidectomy. We hereby report our experience from different centers across India to determine clinical significance of postoperatively elevated PTH levels...

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Published in:Indian journal of endocrinology and metabolism 2020-07, Vol.24 (4), p.366-372
Main Authors: Kota, Sunil, Kota, Siva, Jammula, Sruti, Bhargav, P, Sahoo, Abhay, Das, Sambit, Talluri, Satish, Kongara, Srikanth, S Krishna, S, Modi, K
Format: Article
Language:English
Subjects:
Creatinine
Hyperparathyroidism
Medical research
normocalcemia
Original
parathormone
Parathyroid hormones
parathyroidectomy
Phosphatase
Phosphates
primary hyperparathyroidism
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container_title Indian journal of endocrinology and metabolism
container_volume 24
creator Kota, Sunil
Kota, Siva
Jammula, Sruti
Bhargav, P
Sahoo, Abhay
Das, Sambit
Talluri, Satish
Kongara, Srikanth
S Krishna, S
Modi, K
description Background: Persistent elevation of serum parathyroid hormone (PTH) despite normocalcemia have been documented in 8- 40% of patients after parathyroidectomy. We hereby report our experience from different centers across India to determine clinical significance of postoperatively elevated PTH levels and review relevant literature. Methods: We conducted a retrospective case series study and reviewed all the patients who underwent surgery for primary hyperparathyroidism (PHPT) from April 2010 to January 2020. Results: Total of 201 patients was diagnosed as PHPT. Out of available follow-up data of 180 patients, a total of 54 patients (30%) had persistently elevated PTH (PePTH) at 1 month. Patients with PePTH were older with higher preoperative serum calcium, iPTH, alkaline phosphatase and lower serum phosphate and 25-hydroxy vitamin D3 levels. Creatinine clearance was found to be significantly lower in patients with PePTH. Multiple linear regression analysis revealed that preoperative 25-OH D3 concentration, creatinine clearance and iPTH are the factors influencing persistent elevation of PTH levels. Significantly lower serum calcium and higher alkaline phosphatase levels were observed in PePTH patients with preoperative 25-OH D3 levels
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We hereby report our experience from different centers across India to determine clinical significance of postoperatively elevated PTH levels and review relevant literature. Methods: We conducted a retrospective case series study and reviewed all the patients who underwent surgery for primary hyperparathyroidism (PHPT) from April 2010 to January 2020. Results: Total of 201 patients was diagnosed as PHPT. Out of available follow-up data of 180 patients, a total of 54 patients (30%) had persistently elevated PTH (PePTH) at 1 month. Patients with PePTH were older with higher preoperative serum calcium, iPTH, alkaline phosphatase and lower serum phosphate and 25-hydroxy vitamin D3 levels. Creatinine clearance was found to be significantly lower in patients with PePTH. Multiple linear regression analysis revealed that preoperative 25-OH D3 concentration, creatinine clearance and iPTH are the factors influencing persistent elevation of PTH levels. Significantly lower serum calcium and higher alkaline phosphatase levels were observed in PePTH patients with preoperative 25-OH D3 levels &lt;20 ng/mL. Thirty patients at 6 months, 24 patients at 1 year, 18 patients at 2 years and 9 patients at 3 years had eucalcemic PTH elevation. Nine out of 126 (7%) patients with normal initial postoperative calcium and iPTH levels developed PePTH, with none culminating into recurrent hyperparathyroidism. Conclusion: Though the pathogenesis of such a phenomenon still remains to be elucidated, a multifactorial mechanism appears to play a role.</description><identifier>ISSN: 2230-8210</identifier><identifier>EISSN: 2230-9500</identifier><identifier>DOI: 10.4103/ijem.IJEM_212_20</identifier><identifier>PMID: 33088762</identifier><language>eng</language><publisher>India: Wolters Kluwer India Pvt. 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Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright: © 2020 Indian Journal of Endocrinology and Metabolism 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c523e-93495b0df433711e256dad3dd9cb86cfed4e966f7a3e281b75d3a0a5c124997f3</citedby><cites>FETCH-LOGICAL-c523e-93495b0df433711e256dad3dd9cb86cfed4e966f7a3e281b75d3a0a5c124997f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540826/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2532573273?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33088762$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kota, Sunil</creatorcontrib><creatorcontrib>Kota, Siva</creatorcontrib><creatorcontrib>Jammula, Sruti</creatorcontrib><creatorcontrib>Bhargav, P</creatorcontrib><creatorcontrib>Sahoo, Abhay</creatorcontrib><creatorcontrib>Das, Sambit</creatorcontrib><creatorcontrib>Talluri, Satish</creatorcontrib><creatorcontrib>Kongara, Srikanth</creatorcontrib><creatorcontrib>S Krishna, S</creatorcontrib><creatorcontrib>Modi, K</creatorcontrib><title>Persistent elevation of parathormone levels after surgery for primary hyperparathyroidism</title><title>Indian journal of endocrinology and metabolism</title><addtitle>Indian J Endocrinol Metab</addtitle><description>Background: Persistent elevation of serum parathyroid hormone (PTH) despite normocalcemia have been documented in 8- 40% of patients after parathyroidectomy. We hereby report our experience from different centers across India to determine clinical significance of postoperatively elevated PTH levels and review relevant literature. Methods: We conducted a retrospective case series study and reviewed all the patients who underwent surgery for primary hyperparathyroidism (PHPT) from April 2010 to January 2020. Results: Total of 201 patients was diagnosed as PHPT. Out of available follow-up data of 180 patients, a total of 54 patients (30%) had persistently elevated PTH (PePTH) at 1 month. Patients with PePTH were older with higher preoperative serum calcium, iPTH, alkaline phosphatase and lower serum phosphate and 25-hydroxy vitamin D3 levels. Creatinine clearance was found to be significantly lower in patients with PePTH. Multiple linear regression analysis revealed that preoperative 25-OH D3 concentration, creatinine clearance and iPTH are the factors influencing persistent elevation of PTH levels. Significantly lower serum calcium and higher alkaline phosphatase levels were observed in PePTH patients with preoperative 25-OH D3 levels &lt;20 ng/mL. Thirty patients at 6 months, 24 patients at 1 year, 18 patients at 2 years and 9 patients at 3 years had eucalcemic PTH elevation. Nine out of 126 (7%) patients with normal initial postoperative calcium and iPTH levels developed PePTH, with none culminating into recurrent hyperparathyroidism. 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We hereby report our experience from different centers across India to determine clinical significance of postoperatively elevated PTH levels and review relevant literature. Methods: We conducted a retrospective case series study and reviewed all the patients who underwent surgery for primary hyperparathyroidism (PHPT) from April 2010 to January 2020. Results: Total of 201 patients was diagnosed as PHPT. Out of available follow-up data of 180 patients, a total of 54 patients (30%) had persistently elevated PTH (PePTH) at 1 month. Patients with PePTH were older with higher preoperative serum calcium, iPTH, alkaline phosphatase and lower serum phosphate and 25-hydroxy vitamin D3 levels. Creatinine clearance was found to be significantly lower in patients with PePTH. Multiple linear regression analysis revealed that preoperative 25-OH D3 concentration, creatinine clearance and iPTH are the factors influencing persistent elevation of PTH levels. Significantly lower serum calcium and higher alkaline phosphatase levels were observed in PePTH patients with preoperative 25-OH D3 levels &lt;20 ng/mL. Thirty patients at 6 months, 24 patients at 1 year, 18 patients at 2 years and 9 patients at 3 years had eucalcemic PTH elevation. Nine out of 126 (7%) patients with normal initial postoperative calcium and iPTH levels developed PePTH, with none culminating into recurrent hyperparathyroidism. Conclusion: Though the pathogenesis of such a phenomenon still remains to be elucidated, a multifactorial mechanism appears to play a role.</abstract><cop>India</cop><pub>Wolters Kluwer India Pvt. Ltd</pub><pmid>33088762</pmid><doi>10.4103/ijem.IJEM_212_20</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Creatinine
Hyperparathyroidism
Medical research
normocalcemia
Original
parathormone
Parathyroid hormones
parathyroidectomy
Phosphatase
Phosphates
primary hyperparathyroidism
title Persistent elevation of parathormone levels after surgery for primary hyperparathyroidism
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