Postoperative normocalcemic hyperparathyroidism: a comprehensive analysis of 510 cases

Area of Science:

• Endocrinology
• Surgical Oncology
• Biochemistry

Background:

• Postoperative normocalcemic hyperparathyroidism (NC-HPT) is characterized by elevated parathyroid hormone (PTH) despite normal calcium levels after parathyroidectomy for primary hyperparathyroidism (PHPT).
• Understanding the factors contributing to NC-HPT is crucial for optimizing patient management and outcomes following surgery for PHPT.

Purpose of the Study:

• To investigate demographic, biochemical, and histopathological factors associated with NC-HPT.
• To analyze the follow-up outcomes of patients who develop NC-HPT after parathyroidectomy for PHPT.

Main Methods:

• Retrospective analysis of 510 patients who underwent parathyroidectomy for PHPT.
• Evaluation of preoperative and postoperative biochemical parameters, bone mineral density, and pathological findings.
• Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify predictors of NC-HPT.

Main Results:

• NC-HPT occurred in 20.4% of patients and typically resolved by 30 months post-surgery.
• Elevated preoperative PTH levels (OR: 1.003) and parathyroid hyperplasia (OR: 3.311) were identified as independent predictors of NC-HPT.
• A preoperative PTH cutoff of 298 pg/mL predicted NC-HPT with an AUC of 0.665.

Conclusions:

• NC-HPT is a common but often transient condition following PHPT surgery.
• Preoperative PTH levels and parathyroid hyperplasia are key indicators for identifying patients at risk for NC-HPT.
• Close postoperative monitoring is recommended for patients with identified risk factors for NC-HPT.