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Published online: 2020-05-29
Submitted: 2020-04-30
Accepted: 2020-05-14
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SURGICAL TREATMENT OF PATIENTS WITH PRIMARY HYPERPARATHYROIDISM WITH A RISK OF HYPERCALCEMIC CRISIS

Grzegorz Buła
DOI: 10.5603/EP.a2020.0032

open access

Ahead of print
Original Paper
Published online: 2020-05-29
Submitted: 2020-04-30
Accepted: 2020-05-14

Abstract

Goal of study: To evaluate the effectiveness of surgical treatment in patients with a high risk of hypercalcemic crisis due to primary hyperparathyroidism (PHPT) and to determine the best time to undergo surgery. Methodology Between 2010 and 2019, 627 patients underwent surgery due to PHPT. 62 of the patients or 9.9% (47 women and 15 men, aged 28-79 on average 53.7 years) faced the threat of a parathyroid crisis. In these patients, the average parathyroid hormone (PTH) levels were 774.02 pg / ml (95% CI: 203-1246 pg / ml) and ionized calcium (iCa2 +) 1.91 mmol / l (95% CI: 1.70- 2.2 mmol / l). The PTH postoperative concentration averaged at 37.86 pg / ml (95% CI: 9.91-42.7 pg / ml) and iCa2 + 1.11 mmol / L (95% CI: 1.07-1.21 mmol / L). Bilateral neck exploration was performed in all patients with the removal of the affected parathyroid gland and biopsies of other parts. Histopathological examination revealed adenoma in 42 cases (67.7%), hyperplasia in 16 (25.7%), and parathyroid cancer in 4 of the patients (6.6%). Comparison of tests before and after surgery showed a statistically significant decrease in PTH (p <0.001) and iCa (p <0.001) in blood serum. Conclusions: • A developing hypercalcemic crisis in the course of hyperparathyroidism is an indication for urgent surgical intervention and removal of diseased parathyroid glands. • This type of surgery should be performed as soon as possible, even if there are no imaging tests, only based on an assessment of the general condition of patients and their serum calcium levels.

Abstract

Goal of study: To evaluate the effectiveness of surgical treatment in patients with a high risk of hypercalcemic crisis due to primary hyperparathyroidism (PHPT) and to determine the best time to undergo surgery. Methodology Between 2010 and 2019, 627 patients underwent surgery due to PHPT. 62 of the patients or 9.9% (47 women and 15 men, aged 28-79 on average 53.7 years) faced the threat of a parathyroid crisis. In these patients, the average parathyroid hormone (PTH) levels were 774.02 pg / ml (95% CI: 203-1246 pg / ml) and ionized calcium (iCa2 +) 1.91 mmol / l (95% CI: 1.70- 2.2 mmol / l). The PTH postoperative concentration averaged at 37.86 pg / ml (95% CI: 9.91-42.7 pg / ml) and iCa2 + 1.11 mmol / L (95% CI: 1.07-1.21 mmol / L). Bilateral neck exploration was performed in all patients with the removal of the affected parathyroid gland and biopsies of other parts. Histopathological examination revealed adenoma in 42 cases (67.7%), hyperplasia in 16 (25.7%), and parathyroid cancer in 4 of the patients (6.6%). Comparison of tests before and after surgery showed a statistically significant decrease in PTH (p <0.001) and iCa (p <0.001) in blood serum. Conclusions: • A developing hypercalcemic crisis in the course of hyperparathyroidism is an indication for urgent surgical intervention and removal of diseased parathyroid glands. • This type of surgery should be performed as soon as possible, even if there are no imaging tests, only based on an assessment of the general condition of patients and their serum calcium levels.

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Keywords

Hyperparathyroidism, Primary, Surgery, Hypercalcemic crisis, Parathyroidectomy

About this article
Title

SURGICAL TREATMENT OF PATIENTS WITH PRIMARY HYPERPARATHYROIDISM WITH A RISK OF HYPERCALCEMIC CRISIS

Journal

Endokrynologia Polska

Issue

Ahead of print

Published online

2020-05-29

DOI

10.5603/EP.a2020.0032

Keywords

Hyperparathyroidism
Primary
Surgery
Hypercalcemic crisis
Parathyroidectomy

Authors

Grzegorz Buła

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