Research Status of Normocalcemic Parathormone Elevation after Parathyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CAOShao-bo ,  HUYa

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China;

Corresponding author：

HUYa, Email: huya@pumch.cn

Keywords：

Normocalcemic parathormone elevation; Primary hyperparathyroidism; Parathyroidectomy; Review

DOI：

10.7507/1007-9424.20160293

Video：

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Objective To summarize the research status of normocalcemic parathormone elevation after parathyroidectomy for patients with primary hyperparathyroidism. Methods The related literatures on normocalcemic parathormone elevation after parathyroidectomy were collected and reviewed. Results Most of the patients with primary hyperparathyroidism received radical treatment postoperation. NPE didn't predict failure of operation. The relationship between normocalcemic parathormone elevation and recurrent primary hyperparathyroidism remained to be further explored. Patients with normocalcemic parathormone elevation after parathyroidectomy had a higher risk of cardiovascular disease. Postoperative vitamin D and calcium supplementation could reduce the incidence of normocalcemic parathormone elevation. Conclusions The clinical significance of normocalcemic parathormone elevation is still unknown at present. Further researches of multicenter, huge sample, and long-term follow-up will be necessary.

Citation： CAO Shao-bo, HU Ya. Research Status of Normocalcemic Parathormone Elevation after Parathyroidectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(9): 1146-1150. doi: 10.7507/1007-9424.20160293 Copy

1.	胡亚, 廖泉, 曹少博, 等.原发性甲状旁腺功能亢进术后低钙血症相关因素分析.中国实用外科杂志, 2016, 36(1):119-121.
2.	Dolan JP, Norton JA. Surgery for persistent and recurrent primary hyperparathyroidism//Doherty GM, Skogseid B. Surgical endocrinology. Philadelphia, PA:Lippincott Williams Wilkins, 2001:173-187.
3.	Mizrachi A, Gilat H, Bachar G, et al. Elevated parathyroid hormone levels after parathyroidectomy for primary hyperparathyroidism. Head Neck, 2009, 31(11):1456-1460.
4.	Nordenström E, Westerdahl J, Bergenfelz A. Long-term follow-up of patients with elevated PTH levels following successful exploration for primary hyperparathyroidism. World J Surg, 2004, 28(6):570-575.
5.	Carsello CB, Yen TW, Wang TS. Persistent elevation in serum parathyroid hormone levels in normocalcemic patients after parathyroidectomy:does it matter?. Surgery, 2012, 152(4):575-583.
6.	Solorzano CC, Mendez W, Lew JI, et al. Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism. Arch Surg, 2008, 143(7):659-663.
7.	黄朔, 李明振, 杜井峰, 等.甲状旁腺术后甲状旁腺激素升高伴血钙正常的病例分析.中国普通外科杂志, 2010, 19(11):1183-1186.
8.	Westerdahl J, Valdemarsson S, Lindblom P, et al. Postoperative elevated serum levels of intact parathyroid hormone after surgery for parathyroid adenoma:sign of bone remineralization and decreased calcium absorption. World J Surg, 2000, 24(11):1323-1329.
9.	Mittendorf EA, McHenry CR. Persistent parathyroid hormone elevation following curative parathyroidectomy for primary hyperparathyroidism. Arch Otolaryngol Head Neck Surg, 2002, 128(3):275-279.
10.	Yamashita H, Noguchi S, Moriyama T, et al. Reelevation of parathyroid hormone level after parathyroidectomy in patients with primary hyperparathyroidism:importance of decreased renal parathyroid hormone sensitivity. Surgery, 2005, 137(4):419-425.
11.	Wang TS, Ostrower ST, Heller KS. Persistently elevated parathyroid hormone levels after parathyroid surgery. Surgery, 2005, 138(6):1130-1136.
12.	Bergenfelz A, Valdemarsson S, Tibblin S. Persistent elevated serum levels of intact parathyroid hormone after operation for sporadic parathyroid adenoma:evidence of detrimental effects of severe parathyroid disease. Surgery, 1996, 119(6):624-633.
13.	Beyer TD, Solorzano CC, Prinz RA, et al. Oral vitamin D supplementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism. Surgery, 2007, 141(6):777-783.
14.	Ning L, Sippel R, Schaefer S, et al. What is the clinical significance of an elevated parathyroid hormone level after curative surgery for primary hyperparathyroidism?. Ann Surg, 2009, 249(3):469-472.
15.	Yen TW, Wilson SD, Krzywda EA, et al. The role of parathyroid hormone measurements after surgery for primary hyperparathyroidism. Surgery, 2006, 140(4):665-674.
16.	Denizot A, Pucini M, Chagnaud C, et al. Normocalcemia with elevated parathyroid hormone levels after surgical treatment of primary hyperparathyroidism. Am J Surg, 2001, 182(1):15-19.
17.	Dhillon KS, Cohan P, Darwin C, et al. Elevated serum parathyroid hormone concentration in eucalcemic patients after parathyroidectomy for primary hyperparathyroidism and its relationship to vitamin D profile. Metabolism, 2004, 53(9):1101-1106.
18.	Goldfarb M, Gondek S, Irvin GL 3rd, et al. Normocalcemic parathormone elevation after successful parathyroidectomy:long-term analysis of parathormone variations over 10 years. Surgery, 2011, 150(6):1076-1084.
19.	Mandal AK, Udelsman R. Secondary hyperparathyroidism is an expected consequence of parathyroidectomy for primary hyperparathyroidism:a prospective study. Surgery, 1998, 124(6):1021-1027.
20.	Lundgren E, Rastad J, Ridefelt P, et al. Long-term effects of parathyroid operation on serum calcium and parathyroid hormone values in sporadic primary hyperparathyroidism. Surgery, 1992, 112(6):1123-1129.
21.	Mulder H, Hackeng WH, Koster J, et al. Normocalcemia with persistent increase of parathyroid hormone:a prospective study. Calcif Tissue Int, 1992, 51(1):27-29.
22.	Lang BH, Wong IY, Wong KP, et al. Eucalcemic parathyroid hormone elevation after parathyroidectomy for primary sporadic hyperparathyroidism:risk factors, trend, and outcome. Ann Surg Oncol, 2012, 19(2):584-590.
23.	Lewin IG, Papapoulos SE, Hendy GN, et al. Reversible resistance to the renal action of parathyroid hormone in human vitamin D deficiency. Clin Sci (Lond), 1982, 62(4):381-387.
24.	Nordenström E, Westerdahl J, Isaksson A, et al. Patients with elevated serum parathyroid hormone levels after parathyroidectomy:showing signs of decreased peripheral parathyroid hormone sensitivity. World J Surg, 2003, 27(2):212-215.
25.	Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly:consequences for bone loss and fractures and therapeutic implications. Endocr Rev, 2001, 22(4):477-501.
26.	Schneider DF, Mazeh H, Chen H, et al. Predictors of recurrence in primary hyperparathyroidism:an analysis of 1386 cases. Ann Surg, 2014, 259(3):563-568.
27.	Stuart HC, Harvey A, Pasieka JL. Normocalcemic hyperparathyroidism:preoperatively a disease, postoperatively cured?. Am J Surg, 2014, 207(5):673-681.
28.	Hedbäck G, Odén A, Tisell LE. The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World J Surg, 1991, 15(3):399-407.
29.	Söreide JA, van Heerden JA, Grant CS, et al. Survival after surgical treatment for primary hyperparathyroidism. Surgery, 1997, 122(6):1117-1123.
30.	Stefenelli T, Abela C, Frank H, et al. Cardiac abnormalities in patients with primary hyperparathyroidism:implications for follow-up. J Clin Endocrinol Metab, 1997, 82(1):106-112.
31.	Iwamoto N, Sato N, Nishida M, et al. Low parathyroid hormone levels after parathyroidectomy reduce cardiovascular mortality in chronic hemodialysis patients. Clin Exp Nephrol, 2015, [Epub ahead of print].
32.	McMahon DJ, Carrelli A, Palmeri N, et al. Effect of parathyroidectomy upon left ventricular mass in primary hyperparathyroidism:a meta-analysis. J Clin Endocrinol Metab, 2015, 100(12):4399-4407.
33.	Symons C, Fortune F, Greenbaum RA, et al. Cardiac hypertrophy, hypertrophic cardiomyopathy, and hyperparathyroidism-an association. Br Heart J, 1985, 54(5):539-542.
34.	Vestergaard H, ØStergaard Kristensen L. Normocalcemia and persistent elevated serum concentrations of 1-84 parathyroid hormone after operation for sporadic parathyroid adenoma:evidence of increased morbidity from cardiovascular disease. World J Surg, 2002, 26(6):657-660.
35.	Tordjman KM, Yaron M, Izkhakov E, et al. Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism. Eur J Endocrinol, 2010, 162(5):925-933.
36.	Chen G, Xue Y, Zhang Q, et al. Is normocalcemic primary hyperparathyroidism harmful or harmless?. J Clin Endocrinol Metab, 2015, 100(6):2420-2424.
37.	Carty SE, Roberts MM, Virji MA, et al. Elevated serum parathormone level after 'concise parathyroidectomy' for primary sporadic hyperparathyroidism. Surgery, 2002, 132(6):1086-1093.
38.	Biskobing DM. Significance of elevated parathyroid hormone after parathyroidectomy. Endocr Pract, 2010, 16(1):112-117.
39.	Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine:what clinicians need to know. J Clin Endocrinol Metab, 2011, 96(1):53-58.

1. 胡亚, 廖泉, 曹少博, 等.原发性甲状旁腺功能亢进术后低钙血症相关因素分析.中国实用外科杂志, 2016, 36(1):119-121.
2. Dolan JP, Norton JA. Surgery for persistent and recurrent primary hyperparathyroidism//Doherty GM, Skogseid B. Surgical endocrinology. Philadelphia, PA:Lippincott Williams Wilkins, 2001:173-187.
3. Mizrachi A, Gilat H, Bachar G, et al. Elevated parathyroid hormone levels after parathyroidectomy for primary hyperparathyroidism. Head Neck, 2009, 31(11):1456-1460.
4. Nordenström E, Westerdahl J, Bergenfelz A. Long-term follow-up of patients with elevated PTH levels following successful exploration for primary hyperparathyroidism. World J Surg, 2004, 28(6):570-575.
5. Carsello CB, Yen TW, Wang TS. Persistent elevation in serum parathyroid hormone levels in normocalcemic patients after parathyroidectomy:does it matter?. Surgery, 2012, 152(4):575-583.
6. Solorzano CC, Mendez W, Lew JI, et al. Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism. Arch Surg, 2008, 143(7):659-663.
7. 黄朔, 李明振, 杜井峰, 等.甲状旁腺术后甲状旁腺激素升高伴血钙正常的病例分析.中国普通外科杂志, 2010, 19(11):1183-1186.
8. Westerdahl J, Valdemarsson S, Lindblom P, et al. Postoperative elevated serum levels of intact parathyroid hormone after surgery for parathyroid adenoma:sign of bone remineralization and decreased calcium absorption. World J Surg, 2000, 24(11):1323-1329.
9. Mittendorf EA, McHenry CR. Persistent parathyroid hormone elevation following curative parathyroidectomy for primary hyperparathyroidism. Arch Otolaryngol Head Neck Surg, 2002, 128(3):275-279.
10. Yamashita H, Noguchi S, Moriyama T, et al. Reelevation of parathyroid hormone level after parathyroidectomy in patients with primary hyperparathyroidism:importance of decreased renal parathyroid hormone sensitivity. Surgery, 2005, 137(4):419-425.
11. Wang TS, Ostrower ST, Heller KS. Persistently elevated parathyroid hormone levels after parathyroid surgery. Surgery, 2005, 138(6):1130-1136.
12. Bergenfelz A, Valdemarsson S, Tibblin S. Persistent elevated serum levels of intact parathyroid hormone after operation for sporadic parathyroid adenoma:evidence of detrimental effects of severe parathyroid disease. Surgery, 1996, 119(6):624-633.
13. Beyer TD, Solorzano CC, Prinz RA, et al. Oral vitamin D supplementation reduces the incidence of eucalcemic PTH elevation after surgery for primary hyperparathyroidism. Surgery, 2007, 141(6):777-783.
14. Ning L, Sippel R, Schaefer S, et al. What is the clinical significance of an elevated parathyroid hormone level after curative surgery for primary hyperparathyroidism?. Ann Surg, 2009, 249(3):469-472.
15. Yen TW, Wilson SD, Krzywda EA, et al. The role of parathyroid hormone measurements after surgery for primary hyperparathyroidism. Surgery, 2006, 140(4):665-674.
16. Denizot A, Pucini M, Chagnaud C, et al. Normocalcemia with elevated parathyroid hormone levels after surgical treatment of primary hyperparathyroidism. Am J Surg, 2001, 182(1):15-19.
17. Dhillon KS, Cohan P, Darwin C, et al. Elevated serum parathyroid hormone concentration in eucalcemic patients after parathyroidectomy for primary hyperparathyroidism and its relationship to vitamin D profile. Metabolism, 2004, 53(9):1101-1106.
18. Goldfarb M, Gondek S, Irvin GL 3rd, et al. Normocalcemic parathormone elevation after successful parathyroidectomy:long-term analysis of parathormone variations over 10 years. Surgery, 2011, 150(6):1076-1084.
19. Mandal AK, Udelsman R. Secondary hyperparathyroidism is an expected consequence of parathyroidectomy for primary hyperparathyroidism:a prospective study. Surgery, 1998, 124(6):1021-1027.
20. Lundgren E, Rastad J, Ridefelt P, et al. Long-term effects of parathyroid operation on serum calcium and parathyroid hormone values in sporadic primary hyperparathyroidism. Surgery, 1992, 112(6):1123-1129.
21. Mulder H, Hackeng WH, Koster J, et al. Normocalcemia with persistent increase of parathyroid hormone:a prospective study. Calcif Tissue Int, 1992, 51(1):27-29.
22. Lang BH, Wong IY, Wong KP, et al. Eucalcemic parathyroid hormone elevation after parathyroidectomy for primary sporadic hyperparathyroidism:risk factors, trend, and outcome. Ann Surg Oncol, 2012, 19(2):584-590.
23. Lewin IG, Papapoulos SE, Hendy GN, et al. Reversible resistance to the renal action of parathyroid hormone in human vitamin D deficiency. Clin Sci (Lond), 1982, 62(4):381-387.
24. Nordenström E, Westerdahl J, Isaksson A, et al. Patients with elevated serum parathyroid hormone levels after parathyroidectomy:showing signs of decreased peripheral parathyroid hormone sensitivity. World J Surg, 2003, 27(2):212-215.
25. Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly:consequences for bone loss and fractures and therapeutic implications. Endocr Rev, 2001, 22(4):477-501.
26. Schneider DF, Mazeh H, Chen H, et al. Predictors of recurrence in primary hyperparathyroidism:an analysis of 1386 cases. Ann Surg, 2014, 259(3):563-568.
27. Stuart HC, Harvey A, Pasieka JL. Normocalcemic hyperparathyroidism:preoperatively a disease, postoperatively cured?. Am J Surg, 2014, 207(5):673-681.
28. Hedbäck G, Odén A, Tisell LE. The influence of surgery on the risk of death in patients with primary hyperparathyroidism. World J Surg, 1991, 15(3):399-407.
29. Söreide JA, van Heerden JA, Grant CS, et al. Survival after surgical treatment for primary hyperparathyroidism. Surgery, 1997, 122(6):1117-1123.
30. Stefenelli T, Abela C, Frank H, et al. Cardiac abnormalities in patients with primary hyperparathyroidism:implications for follow-up. J Clin Endocrinol Metab, 1997, 82(1):106-112.
31. Iwamoto N, Sato N, Nishida M, et al. Low parathyroid hormone levels after parathyroidectomy reduce cardiovascular mortality in chronic hemodialysis patients. Clin Exp Nephrol, 2015, [Epub ahead of print].
32. McMahon DJ, Carrelli A, Palmeri N, et al. Effect of parathyroidectomy upon left ventricular mass in primary hyperparathyroidism:a meta-analysis. J Clin Endocrinol Metab, 2015, 100(12):4399-4407.
33. Symons C, Fortune F, Greenbaum RA, et al. Cardiac hypertrophy, hypertrophic cardiomyopathy, and hyperparathyroidism-an association. Br Heart J, 1985, 54(5):539-542.
34. Vestergaard H, ØStergaard Kristensen L. Normocalcemia and persistent elevated serum concentrations of 1-84 parathyroid hormone after operation for sporadic parathyroid adenoma:evidence of increased morbidity from cardiovascular disease. World J Surg, 2002, 26(6):657-660.
35. Tordjman KM, Yaron M, Izkhakov E, et al. Cardiovascular risk factors and arterial rigidity are similar in asymptomatic normocalcemic and hypercalcemic primary hyperparathyroidism. Eur J Endocrinol, 2010, 162(5):925-933.
36. Chen G, Xue Y, Zhang Q, et al. Is normocalcemic primary hyperparathyroidism harmful or harmless?. J Clin Endocrinol Metab, 2015, 100(6):2420-2424.
37. Carty SE, Roberts MM, Virji MA, et al. Elevated serum parathormone level after 'concise parathyroidectomy' for primary sporadic hyperparathyroidism. Surgery, 2002, 132(6):1086-1093.
38. Biskobing DM. Significance of elevated parathyroid hormone after parathyroidectomy. Endocr Pract, 2010, 16(1):112-117.
39. Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine:what clinicians need to know. J Clin Endocrinol Metab, 2011, 96(1):53-58.

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Research Status of Normocalcemic Parathormone Elevation after Parathyroidectomy

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