Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

Arch Endocrinol Metab. 2016 Oct;60(5):465-471. doi: 10.1590/2359-3997000000207. Epub 2016 Oct 10.

Abstract

Objective: Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and it may extend hospitalization durations. The purpose of this study is to determine the predictive factors related to the development of hypocalcemia and hungry bone syndrome (HBS) in patients who underwent parathyroidectomy for PHP.

Materials and methods: Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD, albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1st and 4th days postoperatively, and in the 6th postoperative month, and their neck ultrasound (US) and bone densitometry data were also recorded.

Results: Hypocalcemia was seen in 63 patients (38.4%) on the 1st day after parathyroidectomy. Ten patients (6.1%) had permanent hypocalcemia in the 6th month after surgery. Out of the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP, and BUN values were higher in those patients who developed HBS. Furthermore, HBS was more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who underwent thyroidectomy simultaneously with parathyroidectomy.

Conclusions: As a result, patients who have the risk factors for development of hypocalcemia and HBS should be monitored more attentively during the perioperative period.

MeSH terms

  • Alkaline Phosphatase / blood
  • Blood Urea Nitrogen
  • Calcifediol / blood
  • Calcium / blood
  • Female
  • Humans
  • Hyperparathyroidism / complications*
  • Hyperparathyroidism / surgery*
  • Hypocalcemia / etiology*
  • Magnesium / blood
  • Male
  • Middle Aged
  • Parathyroid Hormone / blood
  • Parathyroidectomy / adverse effects*
  • Phosphates / blood
  • Postoperative Complications / etiology*
  • Postoperative Period
  • Predictive Value of Tests
  • Reference Values
  • Risk Assessment / methods
  • Risk Factors
  • Serum Albumin / analysis
  • Statistics, Nonparametric
  • Syndrome
  • Thyrotropin / blood
  • Time Factors
  • Vitamin D Deficiency

Substances

  • Parathyroid Hormone
  • Phosphates
  • Serum Albumin
  • Thyrotropin
  • Alkaline Phosphatase
  • Magnesium
  • Calcifediol
  • Calcium