Normocalcemic with elevated post-operative parathormone in primary hyperpara-thyroidism: 9 case reports and literature review.
- Author:
Ling Ding XIE
1
;
Na WANG
1
;
Jin Ping ZHANG
1
;
Xin WANG
1
;
Xiao Ping CHEN
1
;
Bo ZHANG
1
;
Shi BU
1
Author Information
1. Department of Endocrinology, China-Japanese Friendship Hospital, Beijing 100029, China.
- Publication Type:Review
- Keywords:
Parathyroid hormone;
Primary hyperparathyroidism;
Vitamin D
- MeSH:
Aged;
Calcium;
China;
Female;
Humans;
Hyperparathyroidism, Primary/surgery*;
Male;
Middle Aged;
Parathyroid Hormone;
Parathyroidectomy;
Retrospective Studies
- From:
Journal of Peking University(Health Sciences)
2021;53(3):573-579
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To summarize and analyze the clinical characteristics of primary hyperpara-thyroidism (PHPT) with normocalcemic parathormone elevation (NPE) after surgical treatment, so as to improve the therapeutic ability and standardized post-operative follow-up of PHPT patients.
METHODS:Nine patients who were diagnosed with PHPT in the Department of Endocrinology of China-Japan Friendship Hospital from August 2017 to November 2019 were selected as the subjects. They all developed NPE within 6 months after surgical treatment. The clinical features and outcomes were collected and analyzed retrospectively, in addition, the related literature was reviewed.
RESULTS:Clinical features: among the 9 patients, 6 were middle-aged and elderly females and 3 were male. The main clinical manifestations were bone pain, kidney stones, nausea and fatigue except for one case of asymptomatic PHPT. Pre-operative examination showed high serum calcium [(3.33±0.48) mmol/L], low serum phosphorus [0.76 (0.74, 0.78) mmol/L], high 24-hour urinary calcium [8.1(7.8, 12.0) mmol/24 h], obviously elevated intact PTH [(546.1±257.7) ng/L], vitamin D deficiency [25-hydroxyvitamin D3 (21.0±5.7) nmol/L]. Serum levels of bone alkaline phosphatase [7 patients 41.3(38.6, 68.4) μg/L, 2 patients >90 μg/L] and N-terminal midcourse osteocalcin (>71.4 μg/L) were significantly elevated. The estimated glomerular filtration rate decreased in 2 patients. Imaging examination: 7 patients had osteoporosis. Renal calculi were found in 3 patients by renal ultrasound. Imaging examination of parathyroid glands found definite lesions in all the patients, including 2 cases of multiple lesions and 7 cases of single lesions.
TREATMENT AND OUTCOME:two patients underwent parathyroidectomy, while other patients were treated with microwave thermal ablation. PTH increased 1 month after therapy [(255.0±101.4) ng/L], and no recurrent lesions were found by parathyroid ultrasound. After combined treatment with cal-cium and vitamin D for six months, PTH decreased significantly and the level of serum calcium remained normal at anytime during the follow-up period.
CONCLUSION:The occurrence of postoperative NPE may be related to the higher pre-operative PTH, vitamin D deficiency and lower creatinine clearance. However, NPE may not predict recurrent hyperthyroidism or incomplete parathyroidectomy. Adequate calcium and vitamin D supplementation after surgery seems to be beneficial for patients with NPE. Post-operative follow-up of PHPT patients should be standardized to prevent and treat post-operative NPE.
