Clinical follow-up of operated pati̇ents with primary hyperparathyroidism

Introduction: PHPT is defined as the state of elevated parathyroid hormone in the combination with high or normal calcium levels. Primary hyperparathyroidism occurs when the gland(s) possessing the autonomous activity produces excess hormones irrespective of high calcium levels. Primary hyperparathyroidism is the third most common endocrine disorder and therefore, it has generated significant attention within research topics. The only curative treatment of primary hyperparathyroidism is surgery. In this cross-sectional study, as a primary goal, considering to the following the postoperative period in patients operated for primary hyperparathyroidism, it is aimed to investigate whether the changes in bone mineral density (BMD) based on the primary hyperparathyroidism and to determine which bone area has more this disease-induced alteration. As the secondary goal, the aim of this study is to emphasize the organ damages (nephrolithiasis, hypertension, creatinine elevation) caused by primary hyperparathyroidism and to evaluate the change of post-operative laboratory findings. Method: This study included 55 patients over the age of 16 (years) who were hospitalized and operated with the diagnosis of Classic pHPT (Eleveted Ca and PTH) at Dicle University Medical Faculty Hospital Endocrinology Department or Endocrinology Policlinic between 01/01/2012- 01/01/2018. The status of the cure and the complications were examined before and after the operation by determining GFR, urinary usg evaluation (nephrolithiasis?), blood tests (creatinine, Ca, P, D vit, Parathormon), the localization with parathyroid scintigraphy, BMD and a 24-hour urinary Ca excretion values. Results: A total of 55 patients, 7 (%13) of which were male, with a mean age of 51 (24-79) years was included. The mean follow-up was 36 months. Bone mineral density was measured in vivo at the lumbar spine , proximal femur and femoral neck by dual photon absorptiometry before surgery and mean 36 months after paratyhroidectomy in 55 patients with primary hyperparathyroidism and the changes in bone mineral density were evaluated. After parathyroidectomy, the proximal femur BMD value (p < 0,013), Z score (p < 0,036) and T score (p < 0,029) and Femur neck Z score (p < 0,001) were significantly increased. When the patients under the age of 50 were evaluated, this increase was only significant in femoral neck Z score (p <0,011) and the patients over 50 years old were evaluated, the increase in femoral neck Z score (p < 0,038) was significant. Conclusion: In patients with classical pHPT, after parathyroiectomy DEXA measurements showed improvement in femoral proximal BMD T and scores and Z scores in femoral neck.