Category: Calcium/Bone Disorders
To determine which patients with primary hyperparathyroidism benefit most from operative intervention, we evaluated preop factors that maybe associated with long term normocalcemia after parathyroidectomy.
In this retrospective cohort study, patients who had parathyroid hormone level >65 pg/mL and had parathyroidectomy in 2006-2015 at a single institution were identified. They were grouped by preop serum calcium levels >10.9 mg/dL (high), and >10.3 but <10.9 mg/dL (intermediate). Patients were excluded if their preop serum calcium level was <10.4 mg/dL. Variables included age, gender, race, history of nephrolithiasis, osteopenia, osteoporosis, GERD, fatigue, anxiety, insomnia, and memory loss. Outcomes included number of patients with postop serum calcium levels and those who had serum calcium level <10.4 mg/dL at 12 months. Statistical analysis included Fisher’s exact tests and multivariable logistic regression analysis. Analysis was performed using SAS 9.3 (SAS Institute, Cary, NC) with a significance level of p<0.05.
Of 705 patients, 397 had high and 308 had intermediate preop serum calcium levels. Postop serum calcium levels at 12 months were available for 221 (55.7%) patients in the high and 143 (46.4%) patients in the intermediate preop serum calcium group (p=0.01). Multivariable factors associated with having 12-month postop serum calcium levels measured are osteopenia (OR 1.52, 95% CI 1.10-2.11, p<0.01), fatigue (OR 1.79, 95% CI 1.29-2.48, p<0.01), insomnia (OR 1.86, 95% CI 1.14-3.05, p=0.01), and high preop serum calcium levels (OR 1.60, 95% CI 1.16-2.20, p<0.01). Normocalcemia at 12 months was achieved in 203 (91.9%) patients in the high and 140 (97.9%) patients in the intermediate preop serum calcium group (p=0.03). Multivariable factors associated with normal 12-month postop serum calcium levels are not having osteoporosis (OR 0.21, 95% CI 0.05-0.96, p=0.04) and GERD (OR 0.22, 95% CI 0.08-0.59, p<0.01), and having intermediate preop serum calcium levels (OR 0.23, 95% CI 0.07-0.74, p=0.01).
Patients with high preop calcium levels are more likely to have long term postop serum calcium level monitoring and a greater likelihood of elevated postop serum calcium levels at 12 months. Variables significantly associated with long term monitoring were osteopenia, fatigue, and insomnia, and better long-term calcium control was found in patients not having osteoporosis and GERD.
Patients with primary hyperparathyroidism who have intermediate preop serum calcium levels and don’t have osteoporosis and GERD have better long-term calcium control.
Amna Khokar– Endocrine Surgery Fellow, NorthShore University, Chicago, Illinois
Huan Yan– Endocrine Surgeon, NorthShore University
Kristine Kuchta– Statistician, NorthShore University, Evanston, Illinois
Jaclyn Pruitt– Report Wrtier/ Data Analyst, NorthShore University HealthSystem
Patricia Park– Clinical Research Associate, NorthShore University
Shabirhusain Abadin– General and Endocrine Surgery Faculty, John H. Stroger Cook County Hospital
Tricia Moo-Young– General and Endocrine Surgeon, NorthShore University
Richard Prinz– Professor, Endocrine Surgery, NorthShore University
David Winchester– Professor, Surgical Oncology, NorthShore University
Endocrine Surgery Fellow
Dr. Amna Khokar is an Endocrine Surgery Fellow at NorthShore University/Stroger Cook County Hospital. She earned a bachelors degree from the University of Virginia in 2009 and a medical degree from Virginia Commonwealth University in 2013. She completed her general surgery residency in 2018 from Virginia Commonwealth University.
General and Endocrine Surgery Faculty
John H. Stroger Cook County Hospital
Dr. Shabirhusain Abadin is a surgeon in Chicago, Illinois and is affiliated with John H. Stroger Jr. Hospital of Cook County. He received his medical degree from Northwestern University Feinberg School of Medicine and has been in practice between 6-10 years. He completed his fellowship in endocrine surgery at MD Anderson.
General and Endocrine Surgeon
Dr. Tricia Moo-Young is a surgeon in Evanston, Illinois and is affiliated with NorthShore University Health-Evanston Hospital. She received her medical degree from University of Chicago Pritzker School of Medicine and has been in practice between 11-20 years.
Professor, Endocrine Surgery
Dr. Richard Prinz is a surgeon in Evanston, Illinois. He received his medical degree from Loyola University Chicago Stritch School of Medicine and has been in practice for more than 20 years.
Professor, Surgical Oncology
Dr. Winchester is endowed chair, department of surgical oncology, NorthShore University HealthSystem, and clinical professor of surgery, University of Chicago Pritzker School of Medicine, Chicago, IL. He serves on the Commission on Cancer and the American Joint Committee on Cancer.