Endocrine Abstracts

Background: Primary hyperparathyroidism is a common endocrine disorder characterized by hypercalcemia, resulting from excessive secretion of parathyroid hormone. Parathyroidectomy, is considered as the definitive treatment for this condition, leading in most cases to remission and resolution of hypercalcemia. However, some patients experience surgical failure. Persistent hyperparathyroidism is defined as persistence of hypercalcemia after parathyroidectomy or recurrence of hypercalcemia within the first 6 months, whereas recurrent hyperparathyroidism is identified when hypercalcemia recurs after a normocalcemic period lasting more than 6 months.

Aim: This study aims to assess the efficacy of surgery as a definitive treatment for hyperparathyroidism by determining the prevalence of persistent and recurrent hyperparathyroidism as well as predisposing factors.

Methods: A retrospective cohort study spanning from 1976 to 2020 at Charles Nicolles Hospital. Two distinct groups were compared: one comprised of patients who achieved remission post-parathyroidectomy, while the other consisted of individuals experiencing persistent or recurrent hyperparathyroidism. Patient demographics, pre-operative biochemical profiles, were collected. Follow-up data included post-operative biochemical assessments. Descriptive statistics were employed to outline the demographic and clinical characteristics of the study, while statistical analyses aimed to identify factors linked to persistent or recurrent hyperparahyroidism.

Results: Eighty patients were included in our study. A sex ratio of 0.21 was observed. The overall success rate of surgery in treating hyperparathyroidism was substantial: 82.5% of the patients achived remission. Notably, no discernible differences were observed in age, or preoperative levels of calcium, phosphate, and PTH levels between the two groups. Big adenoma sizes were more prone to recurrence; (average size 30 mm in the recurrent group versus 24.7 mm). Patients with hyperplasia or carcinoma exhibited a higher likelihood of recurrence compared to those who had adenomas (P=0.017). Conversely, the persistent group demonstrated significantly elevated post-operative PTH levels (P=0.046). Moreover, postoperative hypocalcemia emerged as a predictive factor for achieving remission (P=0.04).

Conclusion: Our study reveals that surgery is a definitive and effective treatment for hyperparathyroidism. Nevertheless, surgical failure is not an uncommon occurrence, highlighting the need for continued vigilance in managing patients operated for primary hyperparathyroidism. Adenoma’s size measurements and anatomopathology results are critical in identifying patients at higher risk of persistent or recurrent hyperparathyroidism. This study provides valuable insights for clinicians to refine their approach in managing those patients ultimately improving long-term prognosis.