Serum Magnesium Measurements After Parathyroidectomy for Primary Hyperparathyroidism: Should It be Routine?
Background Parathyroidectomy is the treatment of choice in primary hyperparathyroidism (PHPT). Following surgery, significant changes in bone and mineral metabolism may follow, but routine magnesium monitoring is not standard practice. The occurrence of significant clinical events linked to hypomagn...
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| Veröffentlicht in: | World journal of surgery 2020-06, Vol.44 (6), p.1898-1904 |
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| creator | Novodvorsky, Peter Lowry, Andrew F. Lim, C. Beverly B. Balasubramanian, Sabapathy P. |
| description | Background
Parathyroidectomy is the treatment of choice in primary hyperparathyroidism (PHPT). Following surgery, significant changes in bone and mineral metabolism may follow, but routine magnesium monitoring is not standard practice. The occurrence of significant clinical events linked to hypomagnesaemia in 3 patients after parathyroidectomy led to our evaluation of magnesium levels after surgery for PHPT.
Methods
Serum magnesium levels before and after parathyroidectomy for PHPT were prospectively evaluated in a single centre over a year. The incidence and severity of hypomagnesaemia and its correlation with other biochemical variables were assessed.
Results
A total of 138 patients underwent parathyroidectomy for PHPT. Pre-operative and day 1 post-operative serum magnesium levels were available in 57/138 (41.3%) and 99/138 (71.7%) patients, respectively. Serum magnesium decreased significantly after surgery (mean ± SD of 0.85 ± 0.08 and 0.75 ± 0.11 mmol/L, respectively,
p
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| doi_str_mv | 10.1007/s00268-020-05425-1 |
| format | Article |
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Parathyroidectomy is the treatment of choice in primary hyperparathyroidism (PHPT). Following surgery, significant changes in bone and mineral metabolism may follow, but routine magnesium monitoring is not standard practice. The occurrence of significant clinical events linked to hypomagnesaemia in 3 patients after parathyroidectomy led to our evaluation of magnesium levels after surgery for PHPT.
Methods
Serum magnesium levels before and after parathyroidectomy for PHPT were prospectively evaluated in a single centre over a year. The incidence and severity of hypomagnesaemia and its correlation with other biochemical variables were assessed.
Results
A total of 138 patients underwent parathyroidectomy for PHPT. Pre-operative and day 1 post-operative serum magnesium levels were available in 57/138 (41.3%) and 99/138 (71.7%) patients, respectively. Serum magnesium decreased significantly after surgery (mean ± SD of 0.85 ± 0.08 and 0.75 ± 0.11 mmol/L, respectively,
p
< 0.001). On the day after parathyroidectomy, 31/99 (31.3%) patients had hypomagnesaemia (<0.70 mmol/L); in 3 of whom it was severe (<0.50 mmol/L). Patients with hypomagnesaemia had lower pre-operative magnesium (mean ± SD of 0.78 ± 0.06 and 0.87 ± 0.07 mmol/L,
p
< 0.001), higher pre-operative calcium [median (IQR) of 2.83 (2.71–2.99) and 2.71 (2.63–2.80) mmol/L,
p
= 0.001] and higher post-operative calcium [median (IQR) of 2.41 (2.30–2.51) and 2.35 (2.28–2.43) mmol/L,
p
= 0.046] compared to those with normomagnesaemia. In addition, these patients demonstrated higher drop in calcium levels after surgery (0.44 ± 0.20 and 0.35 ± 0.18 mmol/L,
p
= 0.033). Magnesium levels after surgery correlated positively with pre-operative magnesium (
r
= 0.561,
p
< 0.001) and post-operative PTH (
r
= 0.210,
p
= 0.037) and negatively with pre-operative adjusted calcium (
r
= − 0.389,
p
< 0.001).
Conclusions
Serum magnesium decreased significantly following parathyroidectomy for PHPT and nearly a third of patients developed post-operative, mostly mild hypomagnesaemia. Whilst routine serum magnesium measurements could facilitate prompt recognition and treatment of this electrolyte disturbance, further research needs to establish the clinical importance of mild hypomagnesaemia in these clinical settings and, if indicated, to devise optimal treatment strategies.]]></description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-020-05425-1</identifier><identifier>PMID: 32055969</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Bone surgery ; Calcium ; Calcium - blood ; Cardiac Surgery ; Evaluation ; Female ; General Surgery ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary - blood ; Hyperparathyroidism, Primary - surgery ; Magnesium ; Magnesium - blood ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Mineral metabolism ; Original Scientific Report ; Parathyroid hormone ; Parathyroidectomy ; Patients ; Surgery ; Thoracic Surgery ; Vascular Surgery</subject><ispartof>World journal of surgery, 2020-06, Vol.44 (6), p.1898-1904</ispartof><rights>The Author(s) 2020</rights><rights>2020 The Author(s)</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4708-b3b926a25296d9d0e4da16950b8ceb031bf6edb8874c0d9caa870b987e80247e3</citedby><cites>FETCH-LOGICAL-c4708-b3b926a25296d9d0e4da16950b8ceb031bf6edb8874c0d9caa870b987e80247e3</cites><orcidid>0000-0002-3292-7586</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-020-05425-1$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-020-05425-1$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,41467,42536,45553,45554,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32055969$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Novodvorsky, Peter</creatorcontrib><creatorcontrib>Lowry, Andrew F.</creatorcontrib><creatorcontrib>Lim, C. Beverly B.</creatorcontrib><creatorcontrib>Balasubramanian, Sabapathy P.</creatorcontrib><title>Serum Magnesium Measurements After Parathyroidectomy for Primary Hyperparathyroidism: Should It be Routine?</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description><![CDATA[Background
Parathyroidectomy is the treatment of choice in primary hyperparathyroidism (PHPT). Following surgery, significant changes in bone and mineral metabolism may follow, but routine magnesium monitoring is not standard practice. The occurrence of significant clinical events linked to hypomagnesaemia in 3 patients after parathyroidectomy led to our evaluation of magnesium levels after surgery for PHPT.
Methods
Serum magnesium levels before and after parathyroidectomy for PHPT were prospectively evaluated in a single centre over a year. The incidence and severity of hypomagnesaemia and its correlation with other biochemical variables were assessed.
Results
A total of 138 patients underwent parathyroidectomy for PHPT. Pre-operative and day 1 post-operative serum magnesium levels were available in 57/138 (41.3%) and 99/138 (71.7%) patients, respectively. Serum magnesium decreased significantly after surgery (mean ± SD of 0.85 ± 0.08 and 0.75 ± 0.11 mmol/L, respectively,
p
< 0.001). On the day after parathyroidectomy, 31/99 (31.3%) patients had hypomagnesaemia (<0.70 mmol/L); in 3 of whom it was severe (<0.50 mmol/L). Patients with hypomagnesaemia had lower pre-operative magnesium (mean ± SD of 0.78 ± 0.06 and 0.87 ± 0.07 mmol/L,
p
< 0.001), higher pre-operative calcium [median (IQR) of 2.83 (2.71–2.99) and 2.71 (2.63–2.80) mmol/L,
p
= 0.001] and higher post-operative calcium [median (IQR) of 2.41 (2.30–2.51) and 2.35 (2.28–2.43) mmol/L,
p
= 0.046] compared to those with normomagnesaemia. In addition, these patients demonstrated higher drop in calcium levels after surgery (0.44 ± 0.20 and 0.35 ± 0.18 mmol/L,
p
= 0.033). Magnesium levels after surgery correlated positively with pre-operative magnesium (
r
= 0.561,
p
< 0.001) and post-operative PTH (
r
= 0.210,
p
= 0.037) and negatively with pre-operative adjusted calcium (
r
= − 0.389,
p
< 0.001).
Conclusions
Serum magnesium decreased significantly following parathyroidectomy for PHPT and nearly a third of patients developed post-operative, mostly mild hypomagnesaemia. Whilst routine serum magnesium measurements could facilitate prompt recognition and treatment of this electrolyte disturbance, further research needs to establish the clinical importance of mild hypomagnesaemia in these clinical settings and, if indicated, to devise optimal treatment strategies.]]></description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bone surgery</subject><subject>Calcium</subject><subject>Calcium - blood</subject><subject>Cardiac Surgery</subject><subject>Evaluation</subject><subject>Female</subject><subject>General Surgery</subject><subject>Humans</subject><subject>Hyperparathyroidism</subject><subject>Hyperparathyroidism, Primary - blood</subject><subject>Hyperparathyroidism, Primary - surgery</subject><subject>Magnesium</subject><subject>Magnesium - blood</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Mineral metabolism</subject><subject>Original Scientific Report</subject><subject>Parathyroid hormone</subject><subject>Parathyroidectomy</subject><subject>Patients</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>24P</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkUtv1TAQhS0EopfCH2CBLLFhExg_Y3eDSkUfqAjEBbG0nGTSpiTxrZ2oyr_HJYVKLBArj6zvHJ2ZQ8hzBq8ZQPkmAXBtCuBQgJJcFewB2TApeMEFFw_JBoSWeWZijzxJ6QqAlRr0Y7InOChltd2QH1uM80A_-osRU3c7oU9zxAHHKdHDdsJIP_vop8slhq7BegrDQtuQf2M3-LjQ02WHcXePdGk4oNvLMPcNPZtohfRLmKduxLdPyaPW9wmf3b375Nvx-69Hp8X5p5Ozo8PzopYlmKISleXac8WtbmwDKBvPtFVQmRorEKxqNTaVMaWsobG196aEypoSDXBZotgnr1bfXQzXM6bJDV2qse_9iGFOjou8vGRWiYy-_Au9CnMcc7pMWSWl5Upliq9UHUNKEVu3W5d3DNxtFW6twuUq3K8qHMuiF3fWczVg80fy-_YZOFiBm67H5T8s3fcP23fHAFKaLBarOGXdeIHxPvg_Mv0EKdClwg</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Novodvorsky, Peter</creator><creator>Lowry, Andrew F.</creator><creator>Lim, C. Beverly B.</creator><creator>Balasubramanian, Sabapathy P.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3292-7586</orcidid></search><sort><creationdate>202006</creationdate><title>Serum Magnesium Measurements After Parathyroidectomy for Primary Hyperparathyroidism: Should It be Routine?</title><author>Novodvorsky, Peter ; Lowry, Andrew F. ; Lim, C. Beverly B. ; Balasubramanian, Sabapathy P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4708-b3b926a25296d9d0e4da16950b8ceb031bf6edb8874c0d9caa870b987e80247e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bone surgery</topic><topic>Calcium</topic><topic>Calcium - blood</topic><topic>Cardiac Surgery</topic><topic>Evaluation</topic><topic>Female</topic><topic>General Surgery</topic><topic>Humans</topic><topic>Hyperparathyroidism</topic><topic>Hyperparathyroidism, Primary - blood</topic><topic>Hyperparathyroidism, Primary - surgery</topic><topic>Magnesium</topic><topic>Magnesium - blood</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Mineral metabolism</topic><topic>Original Scientific Report</topic><topic>Parathyroid hormone</topic><topic>Parathyroidectomy</topic><topic>Patients</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Novodvorsky, Peter</creatorcontrib><creatorcontrib>Lowry, Andrew F.</creatorcontrib><creatorcontrib>Lim, C. Beverly B.</creatorcontrib><creatorcontrib>Balasubramanian, Sabapathy P.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Novodvorsky, Peter</au><au>Lowry, Andrew F.</au><au>Lim, C. Beverly B.</au><au>Balasubramanian, Sabapathy P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Serum Magnesium Measurements After Parathyroidectomy for Primary Hyperparathyroidism: Should It be Routine?</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2020-06</date><risdate>2020</risdate><volume>44</volume><issue>6</issue><spage>1898</spage><epage>1904</epage><pages>1898-1904</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract><![CDATA[Background
Parathyroidectomy is the treatment of choice in primary hyperparathyroidism (PHPT). Following surgery, significant changes in bone and mineral metabolism may follow, but routine magnesium monitoring is not standard practice. The occurrence of significant clinical events linked to hypomagnesaemia in 3 patients after parathyroidectomy led to our evaluation of magnesium levels after surgery for PHPT.
Methods
Serum magnesium levels before and after parathyroidectomy for PHPT were prospectively evaluated in a single centre over a year. The incidence and severity of hypomagnesaemia and its correlation with other biochemical variables were assessed.
Results
A total of 138 patients underwent parathyroidectomy for PHPT. Pre-operative and day 1 post-operative serum magnesium levels were available in 57/138 (41.3%) and 99/138 (71.7%) patients, respectively. Serum magnesium decreased significantly after surgery (mean ± SD of 0.85 ± 0.08 and 0.75 ± 0.11 mmol/L, respectively,
p
< 0.001). On the day after parathyroidectomy, 31/99 (31.3%) patients had hypomagnesaemia (<0.70 mmol/L); in 3 of whom it was severe (<0.50 mmol/L). Patients with hypomagnesaemia had lower pre-operative magnesium (mean ± SD of 0.78 ± 0.06 and 0.87 ± 0.07 mmol/L,
p
< 0.001), higher pre-operative calcium [median (IQR) of 2.83 (2.71–2.99) and 2.71 (2.63–2.80) mmol/L,
p
= 0.001] and higher post-operative calcium [median (IQR) of 2.41 (2.30–2.51) and 2.35 (2.28–2.43) mmol/L,
p
= 0.046] compared to those with normomagnesaemia. In addition, these patients demonstrated higher drop in calcium levels after surgery (0.44 ± 0.20 and 0.35 ± 0.18 mmol/L,
p
= 0.033). Magnesium levels after surgery correlated positively with pre-operative magnesium (
r
= 0.561,
p
< 0.001) and post-operative PTH (
r
= 0.210,
p
= 0.037) and negatively with pre-operative adjusted calcium (
r
= − 0.389,
p
< 0.001).
Conclusions
Serum magnesium decreased significantly following parathyroidectomy for PHPT and nearly a third of patients developed post-operative, mostly mild hypomagnesaemia. Whilst routine serum magnesium measurements could facilitate prompt recognition and treatment of this electrolyte disturbance, further research needs to establish the clinical importance of mild hypomagnesaemia in these clinical settings and, if indicated, to devise optimal treatment strategies.]]></abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32055969</pmid><doi>10.1007/s00268-020-05425-1</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3292-7586</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0364-2313 |
| ispartof | World journal of surgery, 2020-06, Vol.44 (6), p.1898-1904 |
| issn | 0364-2313 1432-2323 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2355941953 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Adult Aged Aged, 80 and over Bone surgery Calcium Calcium - blood Cardiac Surgery Evaluation Female General Surgery Humans Hyperparathyroidism Hyperparathyroidism, Primary - blood Hyperparathyroidism, Primary - surgery Magnesium Magnesium - blood Male Medicine Medicine & Public Health Middle Aged Mineral metabolism Original Scientific Report Parathyroid hormone Parathyroidectomy Patients Surgery Thoracic Surgery Vascular Surgery |
| title | Serum Magnesium Measurements After Parathyroidectomy for Primary Hyperparathyroidism: Should It be Routine? |
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