title: Calcium-lowering medications in patients with primary hyperparathyroidism: intraoperative findings and postoperative hypocalcemia.
abstract: BACKGROUND
  We analyzed how calcium-lowering medications (CLMs) influenced surgical findings in patients with primary hyperparathyroidism.
  
  
  METHODS
  A retrospective review was conducted of 281 patients undergoing surgery for primary hyperparathyroidism. Logistic regression evaluated the relationship between CLM and surgical findings. A mixed-effects model determined the influence of CLMs on these curves.
  
  
  RESULTS
  We found that CLM (P = .018) and a higher serum calcium level (P = .018) were variables making 4-gland hyperplasia less likely. Analysis of intraoperative parathyroid hormone (IOPTH) plots revealed that CLMs altered the kinetics (P = .043). However, the 2 groups did not differ in the number of measurements necessary for a 50% decrease in IOPTH levels. Multivariate logistic regression also revealed that patients taking more than one CLM had an increased association with postoperative hypocalcemia (P = .018).
  
  
  CONCLUSIONS
  Although CLM contributed to differences in IOPTH curves, their use does not require changing standard IOPTH protocol but should alert the surgeon to the risk of postoperative hypocalcemia.
authors.affiliation: Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA. schneiderd@surgery.wisc.edu
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Day
authors.forename: Steven A
authors.initials: SA
authors.lastname: De Jong
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D057966:Calcimimetic Agents / Q000009:adverse effects* / Q000378:metabolism / Q000627:therapeutic use; D002118:Calcium / Q000097:blood; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000378:metabolism / Q000601:surgery*; D006996:Hypocalcemia / Q000097:blood / Q000139:chemically induced*; D016015:Logistic Models; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D010280:Parathyroid Glands / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D010281:Parathyroid Hormone / Q000378:metabolism; D016105:Parathyroidectomy; D011183:Postoperative Complications; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents; D057966:Calcimimetic Agents; D010281:Parathyroid Hormone; D054328:Proton Pump Inhibitors; D002118:Calcium