title: Predictors of tertiary hyperparathyroidism: Who will benefit from parathyroidectomy?
abstract: BACKGROUND
  Tertiary hyperparathyroidism (3°HPT) is hyperparathyroidism with hypercalcemia after renal transplantation. With unclear guidelines for parathyroidectomy (PTX), this study aims to determine which renal transplant patients develop 3°HPT and would benefit from PTX.
  
  
  METHODS
  We performed a retrospective review of patients who received a renal transplant between 1994 and 2013; 105 patients who underwent near total PTX (NTPTX) were compared with 180 renal transplant control patients who did not undergo NTPTX.
  
  
  RESULTS
  Calcium and PTH varied significantly between groups (P < .001). One year before transplant, the mean serum calcium was 9.7 ± 1.1 mg/dL in the NTPTX group versus 9.1 ± 0.9 mg/dL in the control group (P < .01). One month after transplant, the mean calcium in the NTPTX group was 10.4 ± 1.1 versus 9.4 ± 0.6 mg/dL in the control group (P < .001). One year before renal transplant, the median serum PTH level was 723 pg/mL (range, 557-919) in the NTPTX group versus 212 pg/mL (range, 160-439) in the control group (P < .01). One-month post renal transplant, the NTPTX group had a median PTH of 351 pg/mL (range, 199-497) versus 112 pg/mL (range, 73-178) pg/mL in the control group (P < .01).
  
  
  CONCLUSIONS
  Before and after renal transplantation, PTH and calcium levels can serve as predictors of 3°HPT.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Lindel C
authors.initials: LC
authors.lastname: Dewberry
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Sudha
authors.initials: S
authors.lastname: Tata
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Graves
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Collin J
authors.initials: CJ
authors.lastname: Weber
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address: Jsharm3@emory.edu.
authors.forename: Jyotirmay
authors.initials: J
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000150:complications* / Q000175:diagnosis; D006962:Hyperparathyroidism, Secondary / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D018579:Patient Selection; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium