Abstract
Background: The long-term significance of normocalcemic parathormone elevation (NPE) after successful parathyroidectomy for sporadic primary hyperparathyroidism remains unclear. Method: Of 239 consecutive patients who underwent targeted parathyroidectomy with intraoperative parathormone monitoring, 96 were followed for ≥10 years. NPE was defined as a normal serum calcium level and parathormone (PTH) above the normal reference range ≥6 months after successful parathyroidectomy. Recurrence was defined as elevated serum calcium and PTH levels ≥6 months after parathyroidectomy. Risk factors for NPE, patterns of postoperative PTH variation, and 10-year outcomes were analyzed. Results: Of 96 patients followed ≥10 years, 42 had postoperative NPE. Only male gender (P =.008) was a risk factor for NPE, and NPE did not predict recurrence. Three patterns of postoperative NPE were identified in patients with ≥3 PTH measurements over this 10-year period. Group 1 (n = 11): 1 to 2 consecutive PTH elevations; none recurred, and most were explained by physiologic variation. Group 2 (n = 23): multiple PTH fluctuations; 3 recurred, and almost all had physiologic variations. Group 3 (n = 4): PTH always elevated; 2 recurred. Conclusion: Postoperative NPE may be a dynamic, reversible, and transient clinical entity that does not predict recurrence. Nevertheless, patients with postoperative NPE should be monitored and an attempt made to correct any obvious potential causes of PTH elevation.
| Original language | English |
|---|---|
| Pages (from-to) | 1076-1084 |
| Number of pages | 9 |
| Journal | Surgery |
| Volume | 150 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1 2011 |
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ASJC Scopus subject areas
- Surgery
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Normocalcemic parathormone elevation after successful parathyroidectomy : Long-term analysis of parathormone variations over 10 years. / Goldfarb, Melanie; Gondek, Stephen; Irvin, George L.; Lew, John.
In: Surgery, Vol. 150, No. 6, 01.12.2011, p. 1076-1084.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Normocalcemic parathormone elevation after successful parathyroidectomy
T2 - Long-term analysis of parathormone variations over 10 years
AU - Goldfarb, Melanie
AU - Gondek, Stephen
AU - Irvin, George L.
AU - Lew, John
PY - 2011/12/1
Y1 - 2011/12/1
N2 - Background: The long-term significance of normocalcemic parathormone elevation (NPE) after successful parathyroidectomy for sporadic primary hyperparathyroidism remains unclear. Method: Of 239 consecutive patients who underwent targeted parathyroidectomy with intraoperative parathormone monitoring, 96 were followed for ≥10 years. NPE was defined as a normal serum calcium level and parathormone (PTH) above the normal reference range ≥6 months after successful parathyroidectomy. Recurrence was defined as elevated serum calcium and PTH levels ≥6 months after parathyroidectomy. Risk factors for NPE, patterns of postoperative PTH variation, and 10-year outcomes were analyzed. Results: Of 96 patients followed ≥10 years, 42 had postoperative NPE. Only male gender (P =.008) was a risk factor for NPE, and NPE did not predict recurrence. Three patterns of postoperative NPE were identified in patients with ≥3 PTH measurements over this 10-year period. Group 1 (n = 11): 1 to 2 consecutive PTH elevations; none recurred, and most were explained by physiologic variation. Group 2 (n = 23): multiple PTH fluctuations; 3 recurred, and almost all had physiologic variations. Group 3 (n = 4): PTH always elevated; 2 recurred. Conclusion: Postoperative NPE may be a dynamic, reversible, and transient clinical entity that does not predict recurrence. Nevertheless, patients with postoperative NPE should be monitored and an attempt made to correct any obvious potential causes of PTH elevation.
AB - Background: The long-term significance of normocalcemic parathormone elevation (NPE) after successful parathyroidectomy for sporadic primary hyperparathyroidism remains unclear. Method: Of 239 consecutive patients who underwent targeted parathyroidectomy with intraoperative parathormone monitoring, 96 were followed for ≥10 years. NPE was defined as a normal serum calcium level and parathormone (PTH) above the normal reference range ≥6 months after successful parathyroidectomy. Recurrence was defined as elevated serum calcium and PTH levels ≥6 months after parathyroidectomy. Risk factors for NPE, patterns of postoperative PTH variation, and 10-year outcomes were analyzed. Results: Of 96 patients followed ≥10 years, 42 had postoperative NPE. Only male gender (P =.008) was a risk factor for NPE, and NPE did not predict recurrence. Three patterns of postoperative NPE were identified in patients with ≥3 PTH measurements over this 10-year period. Group 1 (n = 11): 1 to 2 consecutive PTH elevations; none recurred, and most were explained by physiologic variation. Group 2 (n = 23): multiple PTH fluctuations; 3 recurred, and almost all had physiologic variations. Group 3 (n = 4): PTH always elevated; 2 recurred. Conclusion: Postoperative NPE may be a dynamic, reversible, and transient clinical entity that does not predict recurrence. Nevertheless, patients with postoperative NPE should be monitored and an attempt made to correct any obvious potential causes of PTH elevation.
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U2 - 10.1016/j.surg.2011.09.017
DO - 10.1016/j.surg.2011.09.017
M3 - Article
VL - 150
SP - 1076
EP - 1084
JO - Surgery (United States)
JF - Surgery (United States)
SN - 0039-6060
IS - 6
ER -