Evaluation of the effect of preoperative diagnostic methods on postoperative hypocalcemia in patients who surgery applied due to primary hyperparathyroid

Primary hyperparathyroidism (PHPT) is a disease characterized by excessive secretion of parathyroid hormone (PTH) as a result of the autonomy of one or more parathyroid (PT) glands located normally or ectopically. While it is most common between the ages of 50-60, it is seen 2-3 times more in women than men. PHPT is caused by a solitary parathyroid adenoma in 80% of cases. The curative treatment method is surgery. One of the complications that may develop after surgery is hypocalcemia. The prolonged and treatment-resistant form of hypocalcemia is called hungry bone syndrome (HBS).Patients who applied between January 2012 and November 2020 and were diagnosed with primary hyperparathyroidism and underwent parathyroidectomy were retrospectively screened. 112 patients' data were included in this study. The patients included in the study were divided into two groups as those with or without HBS. The relation of preop and postop values between groups was compared.28 (25%) of the patients included in the study were male and 84 (75%) were female. While postop HBS was seen in 15 (62.5%) of the participating women, this number was 9 (37.5%) in men. The median age of the patients who included in the study and developed HBS was 59.5 (23-83). It was observed that 11.37 mg / dL, which was determined as the cut-off point for Preop Ca + 2 value, had 83% sensitivity and 58% specificity in terms of predicting the development of HBS. The cut-off point determined for the Perop PTH value was 26.83 pg / ml, and it was observed that it had 79% sensitivity and 81% specificity in terms of predicting HBS development. Significantcut-off point for the % value of Ca+2 decrease is determined by looking at the change rate of Ca+2 values between preop and postop. 1. day. 25.87 % was the significant cut-off point for predicting HBS. The cut-off point for the PTH decrease % value, whichis found significant to predict the development of HBS, was 87.71%. The relationship between preop PTH value and perop PTH value with HBS was examined while calculating this value. As a result, the patient who underwent parathyroidectomy, being over 50 years old, being female, having a large pathological parathyroid gland (> 21 mm) were identified as independent risk factors for HBS development. Results of the current study suggested that among the biochemical parameters measured in the preoperative and postoperative periods; preop measured Ca + 2 value, perop measured PTH value, the rate of change of thePTH value measured perop compared to the preop measured and the rate of change of the postop 1st day Ca + 2 value compared to the preop measured Ca+ 2 value may be parameters that can be used to predict the development of HBS. Studiesinvolving larger patient groups are needed to determine the risk of HBS biochemically.