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

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.