NORMOCALCEMIC
HYPERPARATHORMONEMIA FOLLOWING SUCCESFUL PARATHYROIDECTOMY- PROGNOSTIC AND
CLINICAL SIGNIFICANCE
This
phenomenon is observed in a significant percentage of patients, ranging widely
in the literature (from 9 % to 62 %). Multiple pathogenetic mechanisms are potentially
involved (including vitamin D deficiency, hungry bone syndrome, and parathyroid
hormone resistance), but a compensatory response to remineralization of
cortical bone seems to play the most important role. Remineralization of bone occurs
over 1 to 2 years after surgery, but can continue for up to 4 years following
parathyroidectomy. The elevation in postoperative PTH levels with normal
calcium levels is a transient phenomenon, resolving usually within 6 months of
surgery. In most patients, PTH levels will normalize or decrease within the
next two years. However, compensatory increases in PTH levels have been
documented to persist even for up to 15 years. Patients with normocalcemic parathyroid
hormone elevation following curative parathyroidectomy do not have higher rates
of recurrent hyperparathyroidism than those with normal parathyroid levels.
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