ECE2022 Rapid Communications Rapid Communications 14: Late Breaking (8 abstracts)
1Ankara City Hospital, Endocrinology and Metabolism, Ankara, Turkey; 2Ankara Yildirim Beyazit University, Faculty of Medicine, Endocrinology and Metabolism, Ankara, Turkey
Aim: Postoperative hypocalcemia is seen in 26-42% patients after parathyroidectomy.There are quite a lot of studies investigating preoperative factors that might be used to predict postoperative hypocalcemia in thyroidectomized patients, however there are less studies in parathyroidectomized patients.In this study, our aim was to determine whether any preoperative clinical, laboratory or ultrasonographical feature anticipate hypocalcemia in parathyroidectomized patients due to primary hyperparathyroidism (PHPT).
Material and Methods: All patients operated for PHPT between 20192022 were retrospectively evaluated.Patients undergoing minimally invasive parathyroidectomy were enrolled.Demographic, clinical, ultrasonography and histopathology results were noted and compared in patients with and without hypocalcemia (Group-1 and Group-2, respectively) within two days after surgery.
Results: Of 179 parathyroidectomized patients, 93 were operated with minimally invasive procedure. Postoperative hypocalcemia was observed in 21 (22.6%) patients.Group-1 was younger compared to Group-2 (P=0.036).Gender distribution and presence of osteoporosis were comparable.Nephrolithiasis was less prevalant in Group 1 (P=0.046).Preoperative levels of corrected calcium, phosphorus, magnesium, parathyroid hormone, alkaline phosphatase, 25 OH vitamin D were similar in two groups. Fractional excretion of calcium (FECa) was lower in group-1 (P=0.048).The optimal cut-off level of FECa that was predictive for postoperative hypoprathyroidism was 0.0216 with a sensitivity of 61.9% and specificity of 54.9% (AUC 0.643±0.062, P=0.048).Ultrasonographic and histopathologic diameters and volumes of parathyroid lesions were not different in both groups (p>0.05 for all).Histopathological diagnosis was parathyroid adenoma in 76 (64.5%) patients, parathyroid hyperplasia in 9 (9.7%) patients, and cell-rich parathyroid gland in 8 (8.6%) patients.The distribution of the histopathological results were similar in two groups(P=0.750).
Group-1 (Patients with postoperative hypocalcemia) (n=21, 22.6%) | Group-2 (Patients without postoperative hypocalcemia) (n=72, 77.4%) | P | |
n(%),[median (Q1-Q3)] | n(%),[median (Q1-Q3)] | ||
Age (year) | 45.4±11.8 | 51.9±12.4 | 0.036 |
Gender (women) | 18 (85.7) | 53 (73.6) | 0.251 |
Corrected calcium (N:8.7-10.4 mg/dl) | 10.5 (10.2-10.7) | 10.7 (10.3-11.4) | 0.127 |
Phosphorus (N:2.4-5.1 mg/dl) | 2.9±0.6 | 2.7±4.6 | 0.055 |
Magnesium (1.3-2.7 mg/dl) (n=83) | 2.1±0.1 | 2.0±0.2 | 0.091 |
Alkaline phosphatase (42-98 U/l) (n=91) | 103 (95-128) | 113 (86-144) | 0.950 |
Parathyroid hormone (18.4-80.1 ng/ml) | 188,5 (147.0-210.0) | 191.0 (140.5-281.8) | 0.443 |
25 OH Vitamin D3 (25-80 ng/ml) (n=92) | 19.8 (11.2-23.5) | 16.0 (11.0-22.0) | 0.466 |
Fractional excretion of calcium | 0.0213 (0.0146-0.0229) | 0.0225 (0.0177-0.0279) | 0.048 |
Presence of nephrolithiasis | 4 (19.0) | 31 (43.1) | 0.046 |
Presence of osteoporosis | 10 (47.6) | 26 (36.1) | 0.279 |
Number of removed parathyroid lesions | 1 (1-2) | 1 (1-3) | 0.212 |
Conclusions: Younger patients, patients with lower FECa and without nephrolithiasis undergoing minimally invasive parathyroidectomy for PHPT might require closer follow-up for the development of postoperative hypocalcemia. FECa lower than 0.0216 might help to predict occurrence of postoperative hypocalcemia.