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Published in: Journal of Endocrinological Investigation 5/2023

01-05-2023 | Hypocalcemia | Original Article

Calcitriol supplementation before parathyroidectomy and calcium level after surgery in parathyroid adenoma patients: a randomized controlled trial

Authors: R. Shahriarirad, S. M. Meshkati Yazd, A. Ardekani, A. Mokhtari Ardekani, N. Moradi, S. Nasiri

Published in: Journal of Endocrinological Investigation | Issue 5/2023

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Abstract

Background

Hypocalcemia is the most common complication after parathyroidectomy, contributing to extended hospital stays and higher hospitalization costs. The present study aimed to evaluate whether preoperative Calcitriol could help reduce hypocalcemia rates.

Method

In this randomized controlled trial, we included 80 patients with primary hyperparathyroidism candidates for parathyroidectomy. The intervention group received Calcitriol 0.25 µg/day 1 week before parathyroidectomy. Baseline laboratory data, parathyroid hormone level (before, during, after 5, and 10 min of operation), calcium level (6, 24, and 48 h after operation), and clinical signs and symptoms were recorded.

Results

Of the 80 participants, 40 (mean age: 53.36 ± 12.97) were randomized to the intervention, and 40 (mean age: 52.84 ± 12.32) to the control group. There were no statistically significant differences in age, tumor size, gender, baseline laboratory data, intra-operative PTH, and calcium level 6 and 24 h after the operation. We observed a significantly higher calcium level in the intervention group 48 h post-operation (8.57 ± 0.30 vs. 8.33 ± 0.38). Also, days of hospital stay and symptomatic hypocalcemia rate were significantly lower in the intervention group.

Conclusion

In patients with primary hyperparathyroidism, preoperative Calcitriol may be of value in preventing post-parathyroidectomy hypocalcemia and subsequent complications.
Literature
1.
go back to reference Ellul D, Townsley RB, Clark LJ (2013) Does the pre-operative serum phosphate level predict early hypocalcaemia following parathyroidectomy for primary hyperparathyroidism? Surgeon 11(3):125–129CrossRefPubMed Ellul D, Townsley RB, Clark LJ (2013) Does the pre-operative serum phosphate level predict early hypocalcaemia following parathyroidectomy for primary hyperparathyroidism? Surgeon 11(3):125–129CrossRefPubMed
2.
go back to reference Loewe A, Lutz Y, Nairn D, Fabbri A, Nagy N, Toth N et al (2019) Hypocalcemia-induced slowing of human sinus node pacemaking. Biophys J 117(12):2244–2254CrossRefPubMedPubMedCentral Loewe A, Lutz Y, Nairn D, Fabbri A, Nagy N, Toth N et al (2019) Hypocalcemia-induced slowing of human sinus node pacemaking. Biophys J 117(12):2244–2254CrossRefPubMedPubMedCentral
3.
go back to reference Westerdahl J, Lindblom P, Valdemarsson S, Tibblin S, Bergenfelz A (2000) Risk factors for postoperative hypocalcemia after surgery for primary hyperparathyroidism. Arch Surg 135(2):142–147CrossRefPubMed Westerdahl J, Lindblom P, Valdemarsson S, Tibblin S, Bergenfelz A (2000) Risk factors for postoperative hypocalcemia after surgery for primary hyperparathyroidism. Arch Surg 135(2):142–147CrossRefPubMed
4.
go back to reference Witteveen JE, van Thiel S, Romijn JA, Hamdy NA (2013) Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol 168(3):R45-53CrossRefPubMed Witteveen JE, van Thiel S, Romijn JA, Hamdy NA (2013) Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol 168(3):R45-53CrossRefPubMed
5.
go back to reference McLeod IK, Arciero C, Noordzij JP, Stojadinovic A, Peoples G, Melder PC et al (2006) The use of rapid parathyroid hormone assay in predicting postoperative hypocalcemia after total or completion thyroidectomy. Thyroid 16(3):259–265CrossRefPubMed McLeod IK, Arciero C, Noordzij JP, Stojadinovic A, Peoples G, Melder PC et al (2006) The use of rapid parathyroid hormone assay in predicting postoperative hypocalcemia after total or completion thyroidectomy. Thyroid 16(3):259–265CrossRefPubMed
6.
go back to reference Brasier AR, Nussbaum SR (1988) Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med 84(4):654–660CrossRefPubMed Brasier AR, Nussbaum SR (1988) Hungry bone syndrome: clinical and biochemical predictors of its occurrence after parathyroid surgery. Am J Med 84(4):654–660CrossRefPubMed
7.
go back to reference Mittendorf EA, Merlino JI, McHenry CR (2004) Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management. Am Surg 70(2):114–119 (discussion 9–20)CrossRefPubMed Mittendorf EA, Merlino JI, McHenry CR (2004) Post-parathyroidectomy hypocalcemia: incidence, risk factors, and management. Am Surg 70(2):114–119 (discussion 9–20)CrossRefPubMed
8.
go back to reference Crea N, Pata G, Casella C, Cappelli C, Salerni B (2012) Predictive factors for postoperative severe hypocalcaemia after parathyroidectomy for primary hyperparathyroidism. Am Surg 78(3):352–358CrossRefPubMed Crea N, Pata G, Casella C, Cappelli C, Salerni B (2012) Predictive factors for postoperative severe hypocalcaemia after parathyroidectomy for primary hyperparathyroidism. Am Surg 78(3):352–358CrossRefPubMed
9.
go back to reference Sinha S, Fok M, Ahmad I, Al-Sheikh M, Backhouse C (2020) Shortening postoperative stay after parathyroidectomy–a district general hospital experience. Int Arch Otorhinolaryngol 24(3):e313–e318CrossRefPubMed Sinha S, Fok M, Ahmad I, Al-Sheikh M, Backhouse C (2020) Shortening postoperative stay after parathyroidectomy–a district general hospital experience. Int Arch Otorhinolaryngol 24(3):e313–e318CrossRefPubMed
10.
go back to reference Ho LY, Wong PN, Sin HK, Wong YY, Lo KC, Chan SF et al (2017) Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol 18(1):12CrossRefPubMedPubMedCentral Ho LY, Wong PN, Sin HK, Wong YY, Lo KC, Chan SF et al (2017) Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol 18(1):12CrossRefPubMedPubMedCentral
11.
go back to reference Cheng SP, Liu CL, Chen HH, Lee JJ, Liu TP, Yang TL (2009) Prolonged hospital stay after parathyroidectomy for secondary hyperparathyroidism. World J Surg 33(1):72–79CrossRefPubMed Cheng SP, Liu CL, Chen HH, Lee JJ, Liu TP, Yang TL (2009) Prolonged hospital stay after parathyroidectomy for secondary hyperparathyroidism. World J Surg 33(1):72–79CrossRefPubMed
12.
go back to reference Gao D, Lou Y, Cui Y, Liu S, Cui W, Sun G (2022) Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: a meta-analysis. Ren Fail 44(1):503–512CrossRefPubMedPubMedCentral Gao D, Lou Y, Cui Y, Liu S, Cui W, Sun G (2022) Risk factors for hypocalcemia in dialysis patients with refractory secondary hyperparathyroidism after parathyroidectomy: a meta-analysis. Ren Fail 44(1):503–512CrossRefPubMedPubMedCentral
13.
go back to reference Sun X, Zhang X, Lu Y, Zhang L, Yang M (2018) Risk factors for severe hypocalcemia after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Sci Rep 8(1):7743CrossRefPubMedPubMedCentral Sun X, Zhang X, Lu Y, Zhang L, Yang M (2018) Risk factors for severe hypocalcemia after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Sci Rep 8(1):7743CrossRefPubMedPubMedCentral
14.
go back to reference Heath D, Van’t Hoff W, Barnes A, Gray J (1979) Value of 1-alpha-hydroxy vitamin D3 in treatment of primary hyperparathyroidism before parathyroidectomy. Br Med J 1(6161):450–452CrossRefPubMedPubMedCentral Heath D, Van’t Hoff W, Barnes A, Gray J (1979) Value of 1-alpha-hydroxy vitamin D3 in treatment of primary hyperparathyroidism before parathyroidectomy. Br Med J 1(6161):450–452CrossRefPubMedPubMedCentral
15.
go back to reference Niramitmahapanya S, Sunthornthepvarakul T, Deerochanawong C, Sarinnapakorn V, Athipan P (2011) Role of loading calcitriol to control hypocalcemia after parathyroidectomy in chronic kidney disease. J Med Assoc Thai 94(3):295–302PubMed Niramitmahapanya S, Sunthornthepvarakul T, Deerochanawong C, Sarinnapakorn V, Athipan P (2011) Role of loading calcitriol to control hypocalcemia after parathyroidectomy in chronic kidney disease. J Med Assoc Thai 94(3):295–302PubMed
16.
go back to reference Alsafran S, Sherman SK, Dahdaleh FS, Ruhle B, Mercier F, Kaplan EL et al (2019) Preoperative calcitriol reduces postoperative intravenous calcium requirements and length of stay in parathyroidectomy for renal-origin hyperparathyroidism. Surgery 165(1):151–157CrossRefPubMed Alsafran S, Sherman SK, Dahdaleh FS, Ruhle B, Mercier F, Kaplan EL et al (2019) Preoperative calcitriol reduces postoperative intravenous calcium requirements and length of stay in parathyroidectomy for renal-origin hyperparathyroidism. Surgery 165(1):151–157CrossRefPubMed
17.
go back to reference Corea N (2007) Calcitriol. In: Enna SJ, Bylund DB (eds) xPharm: the comprehensive pharmacology reference. Elsevier, New York, pp 1–5 Corea N (2007) Calcitriol. In: Enna SJ, Bylund DB (eds) xPharm: the comprehensive pharmacology reference. Elsevier, New York, pp 1–5
18.
go back to reference Clair F, Leenhardt L, Bourdeau A, Zingraff J, Robert D, Dubost C et al (1987) Effect of calcitriol in the control of plasma calcium after parathyroidectomy. A placebo-controlled, double-blind study in chronic hemodialysis patients. Nephron 46(1):18–22CrossRefPubMed Clair F, Leenhardt L, Bourdeau A, Zingraff J, Robert D, Dubost C et al (1987) Effect of calcitriol in the control of plasma calcium after parathyroidectomy. A placebo-controlled, double-blind study in chronic hemodialysis patients. Nephron 46(1):18–22CrossRefPubMed
19.
go back to reference Ferreira D, Vilayur E, Gao M, Sankoorikal C, Bendinelli C (2019) Calcitriol loading before total parathyroidectomy with autotransplant in patients with end-stage kidney disease: does it prevent postoperative hypocalcaemia? Intern Med J 49(7):886–893CrossRefPubMed Ferreira D, Vilayur E, Gao M, Sankoorikal C, Bendinelli C (2019) Calcitriol loading before total parathyroidectomy with autotransplant in patients with end-stage kidney disease: does it prevent postoperative hypocalcaemia? Intern Med J 49(7):886–893CrossRefPubMed
20.
go back to reference Parnell KE, Oltmann SC (2018) The surgical management of primary hyperparathyroidism: an updated review. Int J Endocr Oncol 5(1):IJE07CrossRef Parnell KE, Oltmann SC (2018) The surgical management of primary hyperparathyroidism: an updated review. Int J Endocr Oncol 5(1):IJE07CrossRef
21.
go back to reference Steinl GK, Kuo JH (2021) Surgical Management of secondary hyperparathyroidism. Kidney Int Rep 6(2):254–264CrossRefPubMed Steinl GK, Kuo JH (2021) Surgical Management of secondary hyperparathyroidism. Kidney Int Rep 6(2):254–264CrossRefPubMed
22.
go back to reference Norman JG, Politz DE (2007) Safety of immediate discharge after parathyroidectomy: a prospective study of 3,000 consecutive patients. Endocr Pract 13(2):105–113CrossRefPubMed Norman JG, Politz DE (2007) Safety of immediate discharge after parathyroidectomy: a prospective study of 3,000 consecutive patients. Endocr Pract 13(2):105–113CrossRefPubMed
23.
go back to reference Rajeev P, Sutaria R, Ezzat T, Mihai R, Sadler GP (2014) Changing trends in thyroid and parathyroid surgery over the decade: is same-day discharge feasible in the United Kingdom? World J Surg 38(11):2825–2830CrossRefPubMed Rajeev P, Sutaria R, Ezzat T, Mihai R, Sadler GP (2014) Changing trends in thyroid and parathyroid surgery over the decade: is same-day discharge feasible in the United Kingdom? World J Surg 38(11):2825–2830CrossRefPubMed
25.
go back to reference Meyer SK, Zorn M, Frank-Raue K, Buchler MW, Nawroth P, Weber T (2009) Clinical impact of two different intraoperative parathyroid hormone assays in primary and renal hyperparathyroidism. Eur J Endocrinol 160(2):275–281CrossRefPubMed Meyer SK, Zorn M, Frank-Raue K, Buchler MW, Nawroth P, Weber T (2009) Clinical impact of two different intraoperative parathyroid hormone assays in primary and renal hyperparathyroidism. Eur J Endocrinol 160(2):275–281CrossRefPubMed
26.
go back to reference Adler JT, Sippel RS, Chen H (2010) 25-hydroxyvitamin D status does not affect intraoperative parathyroid hormone dynamics in patients with primary hyperparathyroidism. Ann Surg Oncol 17(11):2958–2962CrossRefPubMed Adler JT, Sippel RS, Chen H (2010) 25-hydroxyvitamin D status does not affect intraoperative parathyroid hormone dynamics in patients with primary hyperparathyroidism. Ann Surg Oncol 17(11):2958–2962CrossRefPubMed
27.
go back to reference Mattoo S, Agarwal A, Mayilvaganan S, Mishra P, Agarwal G, Mishra A et al (2021) Role of postoperative intact serum PTH as an early predictor of severe post-thyroidectomy hypocalcemia: a prospective study. J Endocrinol Invest 44(9):1961–1970CrossRefPubMed Mattoo S, Agarwal A, Mayilvaganan S, Mishra P, Agarwal G, Mishra A et al (2021) Role of postoperative intact serum PTH as an early predictor of severe post-thyroidectomy hypocalcemia: a prospective study. J Endocrinol Invest 44(9):1961–1970CrossRefPubMed
28.
go back to reference Lacroix C, Potard G, Thuillier P, Le Pennec R, Prévot J, Roudaut N et al (2022) Use of the parathyroid hormone assay at H6 post thyroidectomy: an early predictor of hypocalcemia. J Endocrinol Invest 45(1):1–8CrossRefPubMed Lacroix C, Potard G, Thuillier P, Le Pennec R, Prévot J, Roudaut N et al (2022) Use of the parathyroid hormone assay at H6 post thyroidectomy: an early predictor of hypocalcemia. J Endocrinol Invest 45(1):1–8CrossRefPubMed
29.
go back to reference Pastoricchio M, Bernardi S, Bortul M, de Manzini N, Dobrinja C (2022) Autofluorescence of parathyroid glands during endocrine surgery with minimally invasive technique. J Endocrinol Invest 45(7):1393–1403CrossRefPubMed Pastoricchio M, Bernardi S, Bortul M, de Manzini N, Dobrinja C (2022) Autofluorescence of parathyroid glands during endocrine surgery with minimally invasive technique. J Endocrinol Invest 45(7):1393–1403CrossRefPubMed
31.
go back to reference Randle RW, Balentine CJ, Wendt E, Schneider DF, Chen H, Sippel RS (2016) Should vitamin D deficiency be corrected before parathyroidectomy? J Surg Res 204(1):94–100CrossRefPubMed Randle RW, Balentine CJ, Wendt E, Schneider DF, Chen H, Sippel RS (2016) Should vitamin D deficiency be corrected before parathyroidectomy? J Surg Res 204(1):94–100CrossRefPubMed
32.
go back to reference Redman C, Bodenner D, Stack B Jr (2009) Role of vitamin D deficiency in continued hyperparathyroidism following parathyroidectomy. Head Neck 31(9):1164–1167CrossRefPubMed Redman C, Bodenner D, Stack B Jr (2009) Role of vitamin D deficiency in continued hyperparathyroidism following parathyroidectomy. Head Neck 31(9):1164–1167CrossRefPubMed
33.
Metadata
Title
Calcitriol supplementation before parathyroidectomy and calcium level after surgery in parathyroid adenoma patients: a randomized controlled trial
Authors
R. Shahriarirad
S. M. Meshkati Yazd
A. Ardekani
A. Mokhtari Ardekani
N. Moradi
S. Nasiri
Publication date
01-05-2023
Publisher
Springer International Publishing
Published in
Journal of Endocrinological Investigation / Issue 5/2023
Electronic ISSN: 1720-8386
DOI
https://doi.org/10.1007/s40618-022-01963-8

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