Importance of Alkaline Phosphatase as a Predictor of Transient Hypoparathyroidism After Parathyroidectomy

Abstract

BackgroundThere are insufficient studies that have investigated the relationship between temporary hypoparathyroidism (hypoPTH) and the preoperative serum alkaline phosphatase (ALP) level in patients with no renal function disorder who have undergone isolated parathyroidectomy. The aim of this study was to determine whether or not the preoperative serum ALP level could be a marker which could predict the development of postoperative temporary hypoPTH. MethodsThis cross-sectional study included 158 patients aged > 18 years who were diagnosed with primary hyperparathyroidism (PHPT) between 2017 and 2022. The demographic data of the patients were retrieved from the hospital records. The patients were separated into two groups according to the serum calcium level after the parathyroidectomy, as the normal group and the temporary hypoPTH group. The determinants of temporary hypoPTH developing after parathyroidectomy in PHPT patients were investigated using multivariate logistic regression analysis. ResultsTemporary hypoPTH was determined in 25.3% of patients. The mean age and 25-O-HD level were determined to be lower in the patients who developed temporary hypoPTH compared to those who did not. The preoperative serum ALP, parathormone, and 24-h urine calcium levels were determined to be higher in the cases that developed temporary hypoPTH. As a result of the regression analysis, only the serum ALP level was determined to be an independent risk factor predicting the development of temporary hypoPTH (p: 0.005, OR: 1.021). In the ROC analysis, when a cutoff value of 119.5 pg/mL was taken for ALP, it was determined to have 73% sensitivity and 72% specificity for the prediction of the development of temporary hypoPTH. ConclusionsThe most appropriate treatment for symptomatic PHPT patients selected with positive imaging is minimally invasive parathyroidectomy. The most important postoperative complications are hypocalcemia and hypoPTH. The preoperative serum ALP level may be helpful in determining patients at risk of developing temporary hypoPTH following parathyroidectomy.