Department of Medicine, Division of Endocrinology, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298, USA.
Endocr Pract. 2010 Jan-Feb;16(1):112-7. doi: 10.4158/EP09122.RA.
To review the prevalence of parathyroid hormone elevation after parathyroidectomy for primary hyperparathyroidism and to discuss possible mechanisms.
A Medline search of the English-language literature published between 1990 and 2009 was performed using the search terms "elevated PTH after parathyroidectomy." All of the identified articles reported either prospective or retrospective studies without control groups. Studies that included patients with secondary or tertiary hyperparathyroidism were not reviewed.
Within 1 week to 5 years after parathyroidectomy, 9% to 62% of patients with a normal serum calcium concentration are reported to have an elevated parathyroid hormone concentration. No evidence suggests that postoperative normocalcemic parathyroid hormone elevation is an indication of surgical failure and recurrent hypercalcemia. Preoperative findings in patients with postoperative parathyroid hormone elevation include lower vitamin D concentration, higher concentrations of bone turnover markers, and higher parathyroid hormone concentration. Potential mechanisms for parathyroid hormone elevation in the setting of normocalcemia include vitamin D deficiency, hungry bone syndrome, and parathyroid hormone resistance. Study findings suggest a possible benefit of postoperative calcium and vitamin D supplementation, but no randomized trials have been done.
Elevation of parathyroid hormone commonly occurs after parathyroidectomy for primary hyperparathyroidism, although the underlying mechanism remains unclear.
回顾原发性甲状旁腺功能亢进症甲状旁腺切除术后甲状旁腺激素升高的发生率，并探讨可能的机制。
使用“甲状旁腺切除术后甲状旁腺激素升高”的检索词，对 1990 年至 2009 年间发表的英文文献进行了 Medline 搜索。所有确定的文章均报告了前瞻性或回顾性研究，而无对照组。未对包括继发性或三发性甲状旁腺功能亢进症患者的研究进行综述。
甲状旁腺切除术后 1 周到 5 年内，有 9%至 62%的血钙正常的患者报告甲状旁腺激素浓度升高。没有证据表明术后血钙正常的甲状旁腺激素升高是手术失败和复发性高钙血症的指征。术后甲状旁腺激素升高患者的术前发现包括维生素 D 浓度较低、骨转换标志物浓度较高和甲状旁腺激素浓度较高。在血钙正常的情况下甲状旁腺激素升高的潜在机制包括维生素 D 缺乏、饥饿骨综合征和甲状旁腺激素抵抗。研究结果表明术后钙和维生素 D 补充可能有益，但尚未进行随机试验。
尽管其潜在机制仍不清楚，但原发性甲状旁腺功能亢进症甲状旁腺切除术后甲状旁腺激素升高很常见。
