Endocrine Abstracts

Background: Primary hyperparathyroidism, is defined by hypercalcemia associated with an elevated or inappropriately normal parathyroid hormone(PTH) levels stemming from hyperfunctioning parathyroid glands. It’s a prevalent endocrine disorder. Parathyroidectomy, the surgical excision of affected glands, stands as the definitive treatment, typically resulting in remission and normalization of calcium levels. However, persistent elevation of serum PTH post-parathyroidectomy presents a clinical hurdle, possibly indicating incomplete resolution of the condition or other contributing factors.

Aim: This study aims to ascertain the prevalence of persistent elevated PTH levels among patients achieving remission post-parathyroidectomy and to delineate predisposing factors associated with this persistence.

Methods: Conducted as a retrospective cohort study spanning from 1976 to 2020 at Charles Nicolles Hospital. The research compared two groups: one consisting of patients with persistent elevation of serum PTH levels post-parathyroidectomy, and the other without such elevation, both achieving biological remission. Data sourced from medical records included demographic data, preoperative biochemical profiles, surgical details, and postoperative outcomes. Descriptive statistics were employed to outline the demographic and clinical characteristics of the study cohort, while statistical analyses, including chi-square tests and logistic regression, aimed to identify factors linked to persistent elevation of serum PTH levels.

Results: We included 42 patients with a sex ratio of 0.23. Parathyroid adenoma was the predominant pathology in 76.2% of cases, followed by diffuse hyperplasia in 14.3%, with one case of parathyroid carcinoma detected. Despite achieving normocalcemia postoperatively, 45.2% of patients exhibited persistent elevation of PTH. Notably, no discernible differences were observed in age, creatinine clearance, histological patterns, adenoma size, or preoperative levels of calcium, phosphate, and alkaline phosphatase between patients with persistent PTH elevation and those without. However, serum vitamin D levels were marginally lower in the persistent PTH group. Patients with persistent PTH elevation experienced significantly higher rates of bone complications (P=0.000). Additionally, a significant association was noted between higher preoperative PTH levels and persistent hyperparathyroidism (P=0.005).

Conclusion: Our study reveals a noteworthy prevalence of persistent elevation in serum parathyroid hormone levels following parathyroidectomy, despite achieving remission. Our findings emphasize the need for continued vigilance in managing primary hyperparathyroidism. Identification of factors associated with persistent PTH elevation, such as higher preoperative PTH levels, underscores the importance of personalized treatment approaches. Further research is warranted to unravel the underlying complications and optimize clinical strategies for managing persistent PTH elevation post-remission.