Introduction Patients with large adenoma and hyperparathyroidism induced hypercalcemic crisis are managed with bisphosphonates and mostly operated in the same sitting. The use of bisphosphonates provides the knife happy endocrine surgeon valuable time for imaging and also protects the patient from cardiac effects of hypercalcemia. The effect of bisphosphonates on parathyroid gland is not clearly understood. In this study, we describe the texture of parathyroid gland after giving zoledronic acid.

Methodology Prospectively maintained surgical data from October 2022 - October 2023 of a single experienced endocrine surgeon in the department of Endocrine and Breast Surgery, SGPGI Lucknow was reviewed and all patients who underwent focused parathyroidectomy for PHPT in hypercalcemic crisis who had received bisphosphonates in the preoperative period were included in the study. Patient demographic details, Serum Calcium, PTH, Vitamin D, size and weight of the gland ex vivo and percentage fall in IOPTH value noted. All patients received Injection Zoledronic acid 4mg and the time duration between administration of bisphosphonate and surgery noted. Histopathology of all adenoma was reviewed by a single pathologist trained in Endocrine pathology. Data was statistically analysed using SPSS

Results Among 10 patients who were included in the study, the mean age was 45.0 ± 15.02 years and Male: Female ratio was 2:3. Mean Serum PTH 75.60 ± 50.09 pmol/L, Serum Calcium 14.28 ± 0.74 mg/dL, ex vivo weight 5.14 ± 6.92 g were noted. Intraoperatively, reduced surface vascularity on adenomas and increased peri-gland adhesions were observed.

Studies with larger cohorts are needed to establish the effect