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Suppressibility of serum levels of PTH by calcium in the immediate postoperative period after surgery for primary hyperparathyroidism

World Journal of Surgery volume 17, pages 806–810 (1993)Cite this article

Abstract

The ability of calcium to suppress the secretion of parathyroid hormone (PTH) is impaired in primary hyperparathyroidism (pHPT). Whether the nonadenomatous glands in pHPT also exhibit altered calcium/PTH homeostasis is not known, but this may be the case since in the immediate postoperative period after surgery for pHPT, hypocalcemia often evolves in spite of a rapid normalization of serum levels of PTH. In this study, therefore, the suppression of serum levels of PTH by an oral calcium load was investigated pre- and postoperatively in 12 patients operated on for parathyroid adenoma. There was no difference in the calcemic response during the calcium load pre- and postoperatively. We found that the suppression of serum levels of PTH by calcium was increased already on the first postoperative day. However, postoperatively, the suppression of serum levels of PTH corrrelated positively to serum levels of ionized calcium and, furthermore, negatively to the weight of the excised parathyroid adenoma and the preoperative serum levels of ionized calcium. The results indicate that the function of the remaining parathyroid glands in patients with parathyroid adenoma could have been altered during the hyperparathyroid state and that postoperative hypocalcemia more readily evolves in patients with severe pHPT and impaired suppressibility of PTH (by calcium) in the remaining parathyroid glands.

Résumé

L'hyperparathyroïdie primitive (HPTp) est caractérisée par une altération du freinage de la sécrétion de la parathormone (PTH) par le calcium. On ne siat pas si les parathyroïdes non adénomateuses présentent aussi une altération dans l'homéostasie calcium/PTH, mais ceci est probable car dans la période postopératoire immédiate après chirurgie sur la parathyroïde pour HPTp, il existe une hypocalcémie malgré une normalisation rapide des taux sériques de PTH. Nous avons étudié la variation des taux de PTH sérique après une charge en calcium per os chez 12 patients, avant et après intervention pour un adénome de la parathyroïde. Il n'y avait aucune différence entre les calcémies pré-et postopératoire après charge calcique chez ces 12 patients. La diminution des taux sériques de PTH par le calcium était exacerbée le lendemain de l'intervention. Après cette date, cependant, la diminution des taux sériques de la PTH corrélait positivement avec les taux sériques de calcium ionisé et négativement avec le poids de l'adénome excisé et les taux sériques préopératoires du calcium ionisé. Ces résultats indiquent que la fonction des glandes parathyroïdes restantes chez le patient ayant un adénome parathyroïde pourrait être altérée pendant l'HPTp et que l'hypocalcémie postopératoire est plus prononcée chez le patient ayant une HPTp sévère et qui présente une incapacité à déprimer la sécrétion de PTH par le calcium dans les glandes parathyroïdes restantes.

Resumen

La capacidad que posee el calcio de suprimir la secreción de hormona paratiroídea (HPT) se encuentra alterada en el híperparatiroidismo primario (pHPT). No se sabe si las glándulas paratiroídes no adenomatosas en pacientes con PHPT también exhiben alteración en la homeostais calcio/HPT; pero bien puede ser así, puesto que en el período postoperatorio inmediato, después de cirugía por pHPT, con frecuencia se desarrolla hipocalcemía a pesar de la rápida nomalización de los niveles séricos de HPT. En el présente estudio se investigó la supresión de los niveles séricos de HPT por una carga oral de calcio en los períodos pre y postoperatorios en 12 pacientes intervenidos por adenoma paratiroídeo. No se encontró diferencia en la respuesta calcémica pre y postoperatoria. Encontramos que la supresión de los niveles sérico de HPT por el calcio se incrementó en el primer día postoperatorío. Sin embargo, en el postopertorío la supresión de los niveles séricos de HPT se correlacionaron positivamente con los niveles séricos de calcio ionizado y negativamente con el peso del adenoma paratiroídeo resecado y los niveles preoperatorios de calcio ionizado. Estos resultados indican que la función en las glándulas paratiroídes residuales en pacientes con adenomas paratiroídeas pueden haber sido alterados en el curso del estado hiperparatiroideo, y que la hipocalcemía postoperatoria se desarrolla más fácilmente en pacientes con severo pHPT y con supresión alterada de la secreción de HPT por calcio en las glándulas residuales.

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  1. Department of Surgery, Lund University, S-221 85, Lund, Sweden

    Anders Bergenfelz M.D., Ph.D. & Bo Ahrén M.D., Ph.D.

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  1. Anders Bergenfelz M.D., Ph.D.
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  2. Bo Ahrén M.D., Ph.D.
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Bergenfelz, A., Ahrén, B. Suppressibility of serum levels of PTH by calcium in the immediate postoperative period after surgery for primary hyperparathyroidism. World J. Surg. 17, 806–810 (1993). https://doi.org/10.1007/BF01659104

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Keywords

  • Adenoma
  • Parathyroid Gland
  • Primary Hyperparathyroidism
  • Parathyroid Adenoma
  • Calcium Load