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Invited Critique
February 2000

Risk Factors for Postoperative Hypocalcemia After Surgery for Primary Hyperparathyroidism—Invited Critique

Arch Surg. 2000;135(2):147. doi:10.1001/archsurg.135.2.147

Symptomatic hypocalcemia occurs unpredictably in a few patients undergoing neck exploration for primary hyperparathyroidism. Conventional wisdom has attributed the likelihood of postoperative hypocalcemia to a variety of risk factors, including severity of the disease itself, eg, a patient with a high preoperative calcium level or a large abnormal gland; the extent or activity of bone disease, sometimes referred to as "hungry bone" syndrome; and intraoperative injury to remaining glands, particularly when it is a reoperative case. The study by Westerdahl et al confirms conventional wisdom in 2 respects. First, intraoperative trauma is a risk factor. Second, hungry bones are also a risk factor if high osteocalcin levels can be used as an indicator of the activity of bone turnover. The study's finding that cardiovascular disease, thought to be one of the sequelae of long-standing primary hyperparathyroidism, might protect against symptomatic hypocalcemia is, on the other hand, counterintuitive and puzzling.

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