Department of Surgery, Mayo Clinic, Rochester, MN.
Division of Endocrinology, Department of Medicine, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester MN.
Ann Surg. 2023 Aug 1;278(2):e309-e313. doi: 10.1097/SLA.0000000000005688. Epub 2022 Aug 26.
There is limited long-term follow-up of patients undergoing parathyroidectomy. Recurrence is described as 4% to 10%. This study evaluated persistence and recurrence of hypercalcemia in primary hyperparathyroidism after parathyroidectomy.
Single-institution retrospective (1965-2010) population-based cohort from Olmsted County (MN) of patients undergoing surgery for primary hyperparathyroidism. Patients' demographic data, preoperative and postoperative laboratory values, clinical characteristics, surgical treatment, and follow-up were noted.
A total of 345 patients were identified, 75.7% female, and median age 58.4 years [interquartile range (IQR): 17.6]. In all, 68% of patients were asymptomatic and the most common symptoms were musculoskeletal complaints (28.4%) and nephrolithiasis (25.6%). Preoperative median serum calcium was 11 mg/dL (IQR: 10.8-11.4 mg/dL), and median parathyroid hormone was 90 pg/mL (IQR: 61-169 pg/dL). Bilateral cervical exploration was performed in 38% and single gland resection in 79% of cases. Median postoperative serum calcium was 9.2 mg/dL (IQR: 5.5-11.3). Nine percent of patients presented persistence of hypercalcemia, and recurrence was found in 14% of patients. Highest postoperative median serum calcium was 10 mg/dL (IQR: 6-12.4), and median number of postoperative calcium measurements was 10 (IQR: 0-102). Postoperative hypercalcemia was identified in 37% of patient. Fifty-three percent were attributed to secondary causes, most commonly medications, 22%. Three percent of patients required treatment for postoperative hypercalcemia. Median time to recurrence and death were 12.2 and 16.7 years, respectively.
Recurrent hypercalcemia after successful parathyroidectomy is higher than previously reported. Most cases are transient and often associated to other factors with only the minority requiring treatment. Long-term follow-up of serum calcium should be considered in patients after successful parathyroidectomy.
甲状旁腺切除术患者的长期随访资料有限。复发率描述为 4%至 10%。本研究评估了甲状旁腺切除术后原发性甲状旁腺功能亢进症患者高钙血症的持续和复发情况。
本研究为单机构回顾性队列研究，对象为明尼苏达州奥姆斯特德县（MN）1965 年至 2010 年间接受甲状旁腺切除术治疗的原发性甲状旁腺功能亢进症患者。记录患者的人口统计学数据、术前和术后实验室值、临床特征、手术治疗和随访情况。
共确定 345 例患者，女性占 75.7%，中位年龄 58.4 岁（四分位距：17.6）。所有患者中，68%为无症状患者，最常见的症状是肌肉骨骼投诉（28.4%）和肾结石（25.6%）。术前中位血清钙为 11mg/dL（四分位距：10.8-11.4mg/dL），中位甲状旁腺激素为 90pg/mL（四分位距：61-169pg/dL）。38%的患者行双侧颈探查术，79%的患者行单腺叶切除术。术后中位血清钙为 9.2mg/dL（四分位距：5.5-11.3）。9%的患者存在持续性高钙血症，14%的患者出现复发。术后中位血清钙最高为 10mg/dL（四分位距：6-12.4），术后中位血钙测量次数为 10 次（四分位距：0-102）。术后发生高钙血症的患者占 37%。53%归因于继发性原因，最常见的是药物，占 22%。3%的患者需要治疗术后高钙血症。复发和死亡的中位时间分别为 12.2 年和 16.7 年。
甲状旁腺切除术后复发性高钙血症高于既往报道。大多数病例是短暂的，常与其他因素相关，只有少数需要治疗。成功甲状旁腺切除术后应考虑长期随访血清钙。
