CLINICAL
SIGNIFICANCE OF NORMOCALCEMIC PARATHYROID HORMONE ELEVATION FOLLOWING
SUCCESSFUL PARATHYROIDECTOMY FOR THE MANAGEMENT OF PRIMARY HYPERPARATHYROIDISM
Parathyroid
hormone (PTH) remains increased in a significant percentage of patients
following successful surgery for primary hyperparathyroidism, ranging from 10 %
up to 60 % (25 % to 35 % in most studies). The evaluation of the success of parathyroidectomy
is based on intraoperative PTH measurement, in association with intraoperative
findings (which should be in accordance with the results of preoperative
localization studies), confirmed by the results of frozen section. Potential mechanisms
responsible for this phenomenon include impaired renal function (specifically, lower
glomerular filtration rates), low 25-OH-vitamin D levels (vitamin D deficiency),
higher bone turnover, parathyroid hormone resistance, bone hungry syndrome etc.
Postoperative mormocalcemic PTH elevation is also associated with higher preoperative
PTH concentration.
There is no
evidence that postoperative normocalcemic PTH elevation is an indication of
surgical failure and recurrent hyperparathyroidism. Postoperative calcium and
vitamin D supplementation may offer a benefit in these patients.
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