Normocalcemia with elevated parathyroid hormone levels after surgical treatment of primary hyperparathyroidism - 03/09/11
, Marco Pucini, M.D. a, Christophe Chagnaud, M.D. b, Geneviève Botti, M.D. c, Jean-François Henry, M.D. aAbstract |
Background: Thirty percent of patients who undergo successful parathyroidectomy for primary hyperparathyroidism show unexplained elevated postoperative serum parathyroid hormone (PTH) levels despite normocalcemia.
Methods: PTH levels were measured monthly in 97 patients for 6 months after parathyroidectomy. Renal function, 25-OH-vitamin D levels, serum alkaline phosphatase levels, osteocalcin, and bone densitometry were evaluated before and 6 months after surgery. PTH reactivity to calcium loading was tested at the sixth month.
Results: Thirty patients had elevated PTH levels despite normocalcemia after parathyroidectomy. Before surgery, these 30 patients had higher PTH and creatinine levels, lower vitamin D levels, and more extensive bone involvement than those with normal postoperative PTH levels. In patients with normal renal function and normal vitamin D levels, postoperative PTH values correlated with preoperative PTH levels but not with bone disease.
Conclusion: In most cases, elevated PTH levels after surgery is an adaptive reaction to renal dysfunction or vitamin D deficiency. If no adaptive cause can be found, persistent hyperparathyroidism must be suspected.
Le texte complet de cet article est disponible en PDF.Keywords : Parathyroid hormone, Parathyroidectomy, Primary hyperparathyroidism, Postoperative period
Plan
Vol 182 - N° 1
P. 15-19 - juillet 2001 Retour au numéro
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