Surgical causes of hyper Cai+ -

A decline in serum calcium occurs within 24 hours after suc- cessful surgery; usually blood calcium falls to low-normal values for 3-5 days until the remaining parathyroid tissue resumes full hormone secretion. Acute postoperative hypocalcemia is likely only if severe bone mineral deficits are present or if injury to all the normal parathyroid glands occurs during surgery. In general, there are few problems encountered in patients with uncompli- cated disease such as a single adenoma (the clear majority), who do not have symptomatic bone disease nor a large deficit in bone mineral, who are vitamin D and magnesium sufficient, and who have good renal and gastrointestinal function. The extent of postoperative hypocalcemia varies with the surgical approach. If all glands are biopsied, hypocalcemia may be transiently symp- tomatic and more prolonged. Hypocalcemia is more likely to be symptomatic after second parathyroid explorations, paicularly when normal parathyroid tissue was removed at the initial operation and when the manipulation and/or biopsy of the remaining normal glands are more extensive in the search for the missing adenoma(Harrison 17 pg 2384)