Parathyroid function after parathyroidectomy: Evaluation by measurement of urinary cAMP

Allen M. Spiegel, S. J. Marx, M. F. Brennan, E. M. Brown, R. W. Downs, D. G. Gardner, M. F. Attie, G. D. Aurbach

Research output: Contribution to journalArticle

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Abstract

We measured urinary cyclic AMP (UcAMP) excretion after parathyroidectomy in order to assess postoperative parathyroid function. Patients undergoing successful treatment for primary hyperparathyroidism were divided into three groups based on therapy required to correct postoperative hypocalcaemia: 1 (n=44) vitamin D not required; 2 (n=17) vitamin D required temporarily (<1 year); 3 (n=10) vitamin D required permanently (>1 year). Patients in group 1 experienced only brief (<7 days) hypocalcaemia. UcAMP fell immediately postoperatively and returned to the normal range (in the majority) within 7 days. Group 2 showed the most severe hyperparathyroidism as judged by preoperative serum calcium, alkaline phosphatase and UcAMP and eight of seventeen showed radiographic evidence of osteitis fibrosa cystica (OFC). Patients in this group developed severe hypocalcaemia postoperatively, but in the majority UcAMP was elevated in proportion to the degree of hypocalcaemia and could be suppressed by raising serum calcium. Hypocalcaemia in these patients was presumably due to calcium entry into bone associated with healing of skeletal disease. Group 3 patients also developed severe postoperative hypocalcaemia but showed significantly lower UcAMP excretion than groups 1 or 2. We conclude that measurement of UcAMP excretion is helpful in the diagnosis and management of postparathyroidectomy hypocalcaemia. The combination of low UcAMP and hypocalcaemia more than 7 days after parathyroidectomy indicates hypoparathyroidism that will usually but not always require permanent therapy with vitamin D. Postoperative hypocalcaemia accompanied by increased UcAMP indicates that parathyroid gland function persists and that lifelong treatment with vitamin D will generally not be required.

Original languageEnglish (US)
Pages (from-to)65-73
Number of pages9
JournalClinical Endocrinology
Volume15
Issue number1
StatePublished - 1981
Externally publishedYes

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Parathyroidectomy
Hypocalcemia
Cyclic AMP
Vitamin D
Calcium
Osteitis Fibrosa Cystica
Hypoparathyroidism
Parathyroid Glands
Primary Hyperparathyroidism
Hyperparathyroidism
Therapeutics
Serum
Alkaline Phosphatase
Reference Values
Bone and Bones

ASJC Scopus subject areas

  • Endocrinology

Cite this

Spiegel, A. M., Marx, S. J., Brennan, M. F., Brown, E. M., Downs, R. W., Gardner, D. G., ... Aurbach, G. D. (1981). Parathyroid function after parathyroidectomy: Evaluation by measurement of urinary cAMP. Clinical Endocrinology, 15(1), 65-73.

Parathyroid function after parathyroidectomy : Evaluation by measurement of urinary cAMP. / Spiegel, Allen M.; Marx, S. J.; Brennan, M. F.; Brown, E. M.; Downs, R. W.; Gardner, D. G.; Attie, M. F.; Aurbach, G. D.

In: Clinical Endocrinology, Vol. 15, No. 1, 1981, p. 65-73.

Research output: Contribution to journalArticle

Spiegel, AM, Marx, SJ, Brennan, MF, Brown, EM, Downs, RW, Gardner, DG, Attie, MF & Aurbach, GD 1981, 'Parathyroid function after parathyroidectomy: Evaluation by measurement of urinary cAMP', Clinical Endocrinology, vol. 15, no. 1, pp. 65-73.
Spiegel AM, Marx SJ, Brennan MF, Brown EM, Downs RW, Gardner DG et al. Parathyroid function after parathyroidectomy: Evaluation by measurement of urinary cAMP. Clinical Endocrinology. 1981;15(1):65-73.
Spiegel, Allen M. ; Marx, S. J. ; Brennan, M. F. ; Brown, E. M. ; Downs, R. W. ; Gardner, D. G. ; Attie, M. F. ; Aurbach, G. D. / Parathyroid function after parathyroidectomy : Evaluation by measurement of urinary cAMP. In: Clinical Endocrinology. 1981 ; Vol. 15, No. 1. pp. 65-73.
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