Endocrine Abstracts

Background: Mild primary hyperparathyroidism (PHPT) is frequently diagnosed in patients with minimal hypercalcaemia whose symptoms might remain sub-clinical or even be absent. In contrast, series of patients with severe PHPT report multiple end-organ failures including suppressed haematopoiesis (Horm Metab Res 1997; 29: 387) and marrow fibrosis (Clin Endo 2009; 70 :527).

Aim: To determine the effect of parathyroidectomy on haemoglobin and haematocrit levels in a recent cohort of patients diagnosed with PHPT.

Methods: A retrospective database was created and catalogued perioperative haemathological parameters, clinical and operative details. Wilcoxon–Signed rank tests were performed comparing pre-operative and post-operative haemoglobin (Hb) and haematocrit levels (Hct).

Results: Seventy-six patients (25M: 51F, 18–89 years old, median 62 years) with biochemical diagnosis of PHPT (hypercalcemia 2.86±0.25 mmol/l, uninhibited/raised PTH levels 32.7±38.2 ρmol/l). Patients underwent scan-directed minimally invasive parathyroidectomy (n=42) or bilateral cervical exploration (n=34) and were disease free at last follow-up between 1–27 months (median 8 months).

Preoperative calcium/PTH and Hb/Hct levels did not correlate. Pre-operative and post-operative haemoglobin levels were higher in males than females (P=0.003 and P=0.004, respectively / Mann–Whitney U tests). There was no difference between pre-operative and post-operative Hb/Hct levels in the population as a whole (P=0.242 and P=0.445 respectively). Male patients with pre-operative anaemia (Hb<11 g/dl) had no significant change in their haemoglobin levels (P=0.859) nor haematocrit levels (P=0.594) after parathyroidectomy. Similarly, female patients with pre-operative anaemia (Hb<10 g/dl) had no significant change in Hb (P=0.184) nor Hct (P=0.109) following parathyroidectomy.

Conclusion: In contrast to historical data and recent series of severe PHPT, we found no significant change in haemoglobin/haematocrit levels following parathyroidectomy. This might be due to earlier treatment in patients with less severe disease.