Rotem Sagiv1, Bertha Delgado2, Re'em Sadeh3, Sagi Shashar3, Merav Fraenkel4, Ksenia M Yegodayev5, Moshe Elkabets5, Ben-Zion Joshua6. 1. Joyce & Irving Goldman Medical School Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva Israel. 2. Pathology Unit Soroka University Medical Center Beer-Sheva Israel. 3. Clinical Research Center of Soroka Medical Center Beer-Sheva Israel. 4. Endocrinology Unit Soroka University Medical Center Beer-Sheva Israel. 5. Shraga Segal Department of Microbiology, Immunology, and Genetics Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva Israel. 6. Department of Otorhinolaryngology - Head and Neck Surgery Barzilai Medical Center Ashkelon Israel.
Abstract
BACKGROUND: Patients with primary hyperparathyroidism (PHPT) treated surgically occasionally have normalized calcium, but persistently high parathyroid hormone (PTH). We hypothesized that a possible explanation for this phenomenon is an underlying hyperplasia rather than adenoma. METHODS: Retrospective cohort of patients who underwent parathyroidectomy for PHPT with biopsy of a normal-appearing parathyroid gland were included. Cellularity level of each biopsy and of the adenoma's rim was determined. RESULTS: Forty-seven patients were included. Of them, 19 (40%) had postoperative normocalcemia but elevated PTH. There was no correlation between cellularity either in the rim or of the normal-appearing parathyroid gland and postoperative PTH. The postoperative high PTH group had higher preoperative PTH (P = 0.001) and larger adenomas (P = 0.025). CONCLUSIONS: High PTH levels after successful parathyroidectomy in patients with primary hyperparathyroidism do not appear to result from underlying hyperplasia. A possible alternative explanation is that these patients have a higher preoperative burden of disease.
BACKGROUND: Patients with primary hyperparathyroidism (PHPT) treated surgically occasionally have normalized calcium, but persistently high parathyroid hormone (PTH). We hypothesized that a possible explanation for this phenomenon is an underlying hyperplasia rather than adenoma. METHODS: Retrospective cohort of patients who underwent parathyroidectomy for PHPT with biopsy of a normal-appearing parathyroid gland were included. Cellularity level of each biopsy and of the adenoma's rim was determined. RESULTS: Forty-seven patients were included. Of them, 19 (40%) had postoperative normocalcemia but elevated PTH. There was no correlation between cellularity either in the rim or of the normal-appearing parathyroid gland and postoperative PTH. The postoperative high PTH group had higher preoperative PTH (P = 0.001) and larger adenomas (P = 0.025). CONCLUSIONS: High PTH levels after successful parathyroidectomy in patients with primary hyperparathyroidism do not appear to result from underlying hyperplasia. A possible alternative explanation is that these patients have a higher preoperative burden of disease.
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