An Unexpected Hyperparathyroidism as a Consequence of Radical Treatment of Primary Hyperparathyroidism

AN UNEXPECTED HYPERPARATHYROIDISM AS A CONSEQUENCE OF RADICAL TREATMENT OF PRIMARY HYPERPARATHYROIDISM (Abstract): The possibility of a rebound of the parathyroid hormone (PTH) plasma level after a temporary return to the physiological range following the ablation of a parathyroid adenoma is a well known phenomenon; on the opposite, the pathogenesis until now is not completely clear. This research includes 25 patients who underwent a parathyroidectomy for sporadic adenoma in the last 14 months. The aim of this communication is to identify the incidence and the duration of this phenomenon. In the 28% of the observations an unexpected increase of the PTH plasma level with normal calcium serum levels and no clinical onset has been detected after a temporary return to the physiological values in the immediate postoperative period. The normalization of the PTH was verified within 10-12 months in the three patients operated more than one year before, turning out to be a temporary phenomenon, as in the most part of the observations of the literature. The most decisive factors about the pathogenesis, after the confirmation of the absence of a mis-knowing parathyroid adenoma, seem to be the persistence of the “hungry bone syndrome”, the modification of the calcium sensibility of the parathyroid cells receptors and a microscopic hyperplasia of the residual parathyroid glands.