Long-term outcome after parathyroidectomy in patients with advanced primary hyperparathyroidism and associated vitamin D deficiency

Abstract

Introduction: Primary hyperparathyroidism (PHPT) is increasingly being recognized in the developing world, but long-term recovery of affected organs after successful parathyroidectomy, remains unaddressed. A study was therefore undertaken to elucidate this aspect of care among our patients.

Methods: Retrospective analysis was done on 82 PHPT patients who underwent parathyroidectomy between 1991 and 2004. Appropriate biochemical and radiological investigations revealed the recovery pattern in target organs.

Results: Follow-up ranged between 2 years and 13 years. Bone pain and muscle weakness disappeared quickly in all patients. Radiographs revealed vigorous but disorderly remineralization in lesions that healed within a median period of 3 months. Mean 25-OH vitamin D levels in the preoperative and postoperative period were 11.6+/-8.7 and 16.94+/-12.77 ng/ml, respectively. Twenty-four of 32 (75%) patients remained persistently vitamin D deficient (mean level 12.15+/-5.45 ng/ml) postoperatively and in the long term (2-13 years; median: 3 years). Kidney disease occurred in 43 patients, and 74% of them became symptom free; in 9 patients it remained static and in 3 others it progressed to end-stage renal disease (ESRD). Seven patients had pancreatitis, 5 became symptom free, and 2 had no relief after failed exploration (n=1) and recurrence (n=1). Overall recurrence and persistence rates were 2.7% each. Of the 5 deaths in the follow-up period, three were due to ESRD and one was due to cerebral metastasis.

Conclusions: In India, PHPT presents at an advanced stage and is associated with vitamin D deficiency. Persistent vitamin D deficiency after operation delays bone recovery. Replenishment of vitamin D stores in the follow-up has to be continuously ensured. Recovery from renal disease is gradual and may never occur in some patients; in others, it may progress to ESRD. Patients recover fully from pancreatitis.