Abstract
Elevated serum concentrations of 1–84 parathyroid hormone (PTH) after operation for sporadic parathyroid adenoma have been re-ported in previous studies, years after operation for primary hyperparathyroidism (pHPT). The cause and significance of this finding have not been elucidated. Primary hyperparathyroidism was diagnosed in 195 patients from January 1987 to December 1998. Operation for pHPT was performed in 124 patients. To evaluate long-term effects of elevated serum 1–84 PTH, biochemical variables and pre- and postoperative diseases were investigated from hospital case records. Of the 124 patients operated on, 103 had a solitary adenoma. Among these patients, 60 had normal serum concentrations of 1–84 PTH and calcium postoperatively, 38 patients had follow-up for more than 12 months (range 12–207 months—group A). Persistent elevated serum concentrations of 1–84 PTH and normocalcemia were found in 23 patients. Fourteen patients had follow-up for more than 12 months (range 15–76 months—group B). Two patients had persistent pHPT, and 18 were normocalcemic, but in this retrospective study data on serum 1–84 PTH were not available. No significant differences were found between groups A and B at the time of diagnosis concerning clinical characteristics. More that 12 months after operation for pHPT, the patients in group B, with persistent elevated serum concentrations of 1–84 PTH, had a significantly (χ 2=11, p=0.005, and power of test 0.66) higher frequency of cardiovascular diseases from ischémie heart disease and hypertension. Persistent elevated serum concentrations of 1–84 PTH after operation for sporadic parathyroid adenoma may be associated with development of cardiovascular disease. This group of patients therefore needs lifelong control and, possibly, medical intervention.
Résumé
Plusieurs publications ont déjà fait état de la persistance de concentrations sériques élevées en 1–84 parathormone (PTH) après intervention pour adénome parathyroïdienne sporadique, parfois des années après l’opération initiale pour hyperparathyroïdie primitive (pHPT). La cause et la signification de ce phénomène n’ont pas encore été élucidées. Parmi 195 patients chez lesquels on a fait le diagnostic d’hyperparathyroïdie primitive entre jan 1987 et déc 1998, 124 ont été opérés. Grâce aux dossiers hospitaliers, les variables biochimiques et la morbidité pré et postopératoire ont été analysés pour évaluer les effets à long terme de l’élévation persistant de la PTH. Parmi les 124 patients opérés, 103 avaient un adénome solitaire dont 60 avaient des concentrations sériques postopératoires normales, en PTH comme en calcium. 38 patients ont été suivis plus de 12 mois (extrêmes 12–207 mois (group A). Chez 23 patients, on a trouvé des concentrations de PTH sériques élevées persistances alors que ces patients étaient normocalcémiques. Quatorze patients ont été suivis pendant plus de 12 mois, extrêmes 15–76 mois (groupe B). Deux patients avaient une pHPT persistante et 18 étaient normocalcémiques mais dans cette étude rétrospective, toutes les données en ce qui concerne la PTH sérique n’étaient pas disponsibles. On n’a trouvé aucune différence significative entre les groupes A et B au moment du diagnostic en ce qui concerne les caractéristiques cliniques. A plus de 12 mois après opération pour pHPT, les patients dans le groupe B avec une concentration de PTH sérique élevée persistante avaient significativement χ 2=11, p=0.005, et puissance du test 0.66) plus de pathologie cardiovasculaire en rapport avec une cardiopathie ischémique et l’hypertension. La persistance de concentrations sériquese élevées de PTH 1–84 après opération pour adénome sporadique de la parathyroïde pourrait être associée au développement de maladie cardiovasculaire. Ce groupe de patients demande donc une surveillance à vie et parfois une intervention chirurgicale.
Resumen
En estudios previos se constató que años después de una intervención quirúrgica por hipeparatiroidismo primario (pHPT) provocado por adenomas esporádicos de paratiroides, persistían concentraciones séricas elevadas de la 1–84 hormona paratiroidea (PTH). Su etiología y significación todavía no se ha dilucidado. Entre enero de 1987 ydiciembre de 1998, 195 pacientes fueron diagnosticados de hiperparatiroidismo primario, operándose 124. Merced a las historias clínicas, parámetros bioquímicos pre y postoperatorios se investigaron los efectos tardíos de la elevación sérica de la PTH. De los 124 pacientes intervenidos, 103 presentaban un adenoma solitario. De ellos, 60 mostraron valores séricos postoperatorios normales tanto de PTH como del calcio; 38 pacientes con un seguimiento superior a 12 meses (rango 12–207 meses) constituyeron el denominado grupo A. En 23 pacientes se registraron concentraciones séricas elevadas de PTH con normoclacemia; 14 pacientes con seguimientos superiores a los 12 meses (rango 15–76 meses) constituyeron el grupo B. Dos pacientes presentaron un pHPT recidivante; 18 eran normocalcémicos pero las cifras retrospectivas de PTH no se pudieron encontrarse en la búsqueda retrospectiva. No se observaron diferencias significativas por lo que al diagnóstico y características clínicas se refiere entre los pacientes del grupo A y B. Transcurridos más de 12 meses desde la operación por pHPT, en los pacientes del grupo B, con persistencia de concentraciones séricas elevadas de PTH, se desarrollaron con más frecuencia (χ 2=11, p=0.005, poder del test 0.66) enfermedades cardiovasculares debidas a isquemia cardiaca e hipertensión. El mantenimiento de concentraciones séricas elevadas de la 1–84 hormona paratiroidea tras la operación por adenoma esporádico de paratiroides provoca el desarrollo de enfermedades cardiovasculares. Este grupo de pacientes requiere un seguimiento de control a lo largo de toda su vida y posiblemente, un tratamiento médico.
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Published Online: March 1, 2002
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Vestergaard, H., Kristensen, L.Ø. Normocalcemia and persistent elevated serum concentrations of 1–84 parathyroid hormone after operation for sporadic parathyroid adenoma: evidence of increased morbidity from cardiovascular disease. World J. Surg. 26, 657–660 (2002). https://doi.org/10.1007/s00268-001-0285-z
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DOI: https://doi.org/10.1007/s00268-001-0285-z