open access

Vol 71, No 5 (2020)
Original paper
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 hypercalcaemic crisis

Grzegorz Buła, Grzegorz Kowalski, Henryk Koziołek, Dominika Żądło, Adam Bednarczyk, Adam Buła, Agata Gawrychowska, Jacek Gawrychowski
DOI: 10.5603/EP.a2020.0032
·
Endokrynologia Polska 2020;71(5):392-396.

open access

Vol 71, No 5 (2020)
Original Paper
Published online: 2020-05-29
Submitted: 2020-04-30
Accepted: 2020-05-14

Abstract

Introduction: The objective of the work was to evaluate the effectiveness of surgical treatment in patients with a high risk of hypercalcaemic crisis due to primary hyperparathyroidism (PHPT) and to determine the best time to undergo surgery.

Material and methods and Results: Between 2010 and 2019, 627 patients underwent surgery due to PHPT. Sixty-two patients (9.9%) (47 women and 15 men, aged 28–79 years, 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 ionised 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 four 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 hypercalcaemic crisis in the course of hyperparathyroidism is an indication for preoperative intensive medical therapy, along with 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 the patient and their serum calcium levels.

Abstract

Introduction: The objective of the work was to evaluate the effectiveness of surgical treatment in patients with a high risk of hypercalcaemic crisis due to primary hyperparathyroidism (PHPT) and to determine the best time to undergo surgery.

Material and methods and Results: Between 2010 and 2019, 627 patients underwent surgery due to PHPT. Sixty-two patients (9.9%) (47 women and 15 men, aged 28–79 years, 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 ionised 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 four 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 hypercalcaemic crisis in the course of hyperparathyroidism is an indication for preoperative intensive medical therapy, along with 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 the patient and their serum calcium levels.

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Keywords

hyperparathyroidism; primary; surgery; hypercalcaemic crisis; parathyroidectomy

About this article
Title

Surgical treatment of patients with primary hyperparathyroidism with a risk of hypercalcaemic crisis

Journal

Endokrynologia Polska

Issue

Vol 71, No 5 (2020)

Article type

Original paper

Pages

392-396

Published online

2020-05-29

DOI

10.5603/EP.a2020.0032

Bibliographic record

Endokrynologia Polska 2020;71(5):392-396.

Keywords

hyperparathyroidism
primary
surgery
hypercalcaemic crisis
parathyroidectomy

Authors

Grzegorz Buła
Grzegorz Kowalski
Henryk Koziołek
Dominika Żądło
Adam Bednarczyk
Adam Buła
Agata Gawrychowska
Jacek Gawrychowski

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