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Review
. 2020 Aug;69(2):402-409.
doi: 10.1007/s12020-020-02344-y. Epub 2020 May 21.

Late-onset postsurgical hypoparathyroidism following parathyroidectomy for recurrent primary hyperparathyroidism: a case report and literature review

Antonella Semeraro  1 , Elizabeth Helen Kemp  2 , Elena Pardi  1 , Agostino Di Certo  1 , Claudio Marcocci  1 , Filomena Cetani  3
Affiliations
Review

Late-onset postsurgical hypoparathyroidism following parathyroidectomy for recurrent primary hyperparathyroidism: a case report and literature review

Antonella Semeraro et al. Endocrine. 2020 Aug.

Abstract

Purpose: Previously in 1987, a 21-year-old male was diagnosed with primary hyperparathyroidism (PHPT) when a right inferior parathyroid adenoma was removed. PHPT recurred after 3 and 6 years and on both occasions was cured by resection of parathyroid adenomas. At 52 years of age, the patient developed a late-onset hypoparathyroidism (HP), even though postsurgical HP typically occurs as a transient or permanent form soon after neck surgery. The purpose of this work was to report the follow-up of the patient and to review prior cases of late-onset postsurgical HP.

Methods: Prior cases of late-onset postsurgical HP were searched and reviewed focusing on clinical and biochemical features.

Results: The patient's asymptomatic hypocalcemia with total serum calcium at 8.2 mg/dL was initially documented in September 2018; PTH was inappropriately low at 15 ng/mL. In February 2020, a mild hypocalcemia was confirmed with low-normal PTH at 15 ng/mL. Autoimmune and familial causes of HP were ruled out including the presence of stimulating autoantibodies against calcium-sensing receptor. Instead, a progressive damage or atrophy of the parathyroid gland(s) ensuing years after surgery is believed to have led to the patient's hypocalcemia. All 19 previously reported cases of late-onset postsurgical HP occurred after thyroid surgery, with no examples of the condition being found following parathyroidectomy.

Conclusions: The case highlights the rare occurrence of late-onset postsurgical HP in a patient who had had multiple parathyroidectomies for PHPT. Thus, monitoring serum calcium, phosphate, and PTH during follow-up of such patients is recommended.

Keywords: CDC73; Hyperparathyroidism-jaw tumor syndrome; Parafibromin; Parathyroidectomy.

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