Treatment of Hyperparathyroidism (SHPT)

Hernandes, Fabiana Rodrigues; Goldenstein, Patricia Taschner; Custódio, Melani Ribeiro

doi:10.1590/2175-8239-jbn-2021-s107

Cited by 4 publications

(4 citation statements)

References 40 publications

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“…Another important factor to be discussed is that the mean PTH value after surgery remained adequate, allowing most patients (83.34%) not to require the use of calcium carbonate in the long term, consequently reducing the use of medication and unwanted side effects, such as intestinal constipation and gastric disorders. None of the patients in the evaluated group presented insufficient PTH values (lowest value in 5 years of 37.5 pg/mL), therefore there weren't any case of definitive hypoparathyroidism 15 .…”

Section: Discussionmentioning

confidence: 88%

“…Multicenter studies have shown that in patients with TTPH, the timing of the parathyroid intervention had no impact on long-term renal function, and the decrease in PTH values (pre-and post-PTX value decay) did not influence renal graft deterioration 13 . The analysis of intraoperative PTH decay for this model of surgery does not present standardized values, but we can consider the mean value found of 73% as acceptable since in the longterm evaluation we did not have PTH values outside the recommended range for the study group 14,15 . Another important factor to be discussed is that the mean PTH value after surgery remained adequate, allowing most patients (83.34%) not to require the use of calcium carbonate in the long term, consequently reducing the use of medication and unwanted side effects, such as intestinal constipation and gastric disorders.…”

Section: Discussionmentioning

confidence: 92%

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Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Rosano

2023

MRAJ

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Introduction: Parathyroid hormone, is one the controllers of calcium homeostasis, is synthesized and secreted by the parathyroid glands. They can become hyper functioning, generate excessive amounts of PTH, and determine the clinical-laboratory picture called hyperparathyroidism. When hyperparathyroidism is a consequence of a pre-existing metabolic imbalance, it is called secondary. Secondary hyperparathyroidism is thus an acquired disorder represented by parathyroid hypersecretion in response to calcium homeostasis disorders. Chronic kidney disease is a condition often associated with secondary hyperparathyroidism. It is a heterogeneous disorder characterized by varying degrees of stimulation and suppression of PTH, being associated with hyperplasia of the parathyroid glands. Material and Method: The present study is a historic prospective cohort analysis of patients undergoing subtotal parathyroidectomy, keeping a parathyroid gland intact in its bed, by tertiary hyperparathyroidism. Result: 44 patients between 30 and 75 years of age were selected, with a median of 49.5 years for the group, divided equally between men and women. Conservative treatment time was 36.75 months and hemodialysis time was 67.33 months. Renal transplantation time was 42.64 months, with PTH value on the day of renal transplantation of 822.03 pg/mL. On the day of surgery, the PTH value was 170.9 pg/mL, reaching an average value of 77.2 after 5 years. The initial value of ionic calcium was 1.477 mmol/L and a final value of 1.299 mmol/L after 5 years. Conclusion: The evaluation of the present study allows us to conclude that subtotal parathyroidectomy, keeping a parathyroid gland intact in its bed, is a safe and effective technical option in the surgical treatment of patients with tertiary hyperparathyroidism.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 92%

Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Rosano

2023

MRAJ

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“…Hyperparathyroidism secondary (SHPT) to chronic kidney disease (CKD) is characterized by elevated serum levels of parathyroid hormone (PTH), hyperplasia of the parathyroid glands, high turnover bone disease and cardiovascular disease 1 , 2 , 3 . The PTH level considered adequate for patients with CKD stage 5D is situated between two and nine times the threshold value of the dosage method 1 .…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness analysis of cinacalcet vs. paricalcitol in the treatment of hyperparathyroidism secondary to chronic kidney disease

et al. 2023

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Introduction For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics. Among the mentioned drugs, the SUS provides oral calcitriol, paricalcitol and cinacalcet. Objectives: Develop cost-effectiveness (CE) and budgetary impact (BI) analysis of cinacalcet versus paricalcitol for patients on dialysis with SHPT, from the perspective of SUS. Methodology: A decision tree model was constructed for CE analysis, which considered the outcome of avoided parathyroidectomy and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of which was measured demand and other epidemiological, based on data from the Brazilian Society of Nephrology (BSN). Results: The CE analysis showed that the use of cinacalcet results in one-off savings of R$1,394.64 per year and an incremental effectiveness of 0.08, in relation to avoided parathyroidectomy. The incremental CE ratio (ICER) was - R$ 17,653.67 per avoided parathyroidectomy for cinacalcet, as it was more effective and cheaper compared to paricalcitol. As for the BI analysis, it was estimated that the incremental BI with the expansion of the use of cinacalcet in the SUS will be between - R$ 1,640,864.62 and R$ 166,368.50 in the first year, considering the main and the epidemiological scenarios. At the end of 5 years after the expansion of use, an BI was estimated between - R$ 10,740,743.86 and - R$ 1,191,339.37; considering the same scenarios. Conclusion: Cinacalcet was dominant to avoid parathyroidectomies, being cost-effective.

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“…The current treatment of SHPT principally consists of drug therapy and surgery ( 4 ). The Global Kidney Disease Guidelines recommend parathyroidectomy for patients with severe hyperparathyroidism who are in chronic kidney disease (CKD) stages 3–5 and in whom drug therapy fails ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Construction and validation of a predictive model for hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism

Cheng

Zhang

et al. 2022

Front. Endocrinol.

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ObjectiveWe aimed to construct and validate a predictive model for the risk of hypocalcemia following parathyroidectomy (PTX) for the treatment of secondary(renal) hyperparathyroidism (SHPT).MethodsInformation regarding patients with SHPT who underwent PTX between January 2019 and April 2022 was collected retrospectively. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for hypocalcemia following PTX and to construct predictive models. The areas under the receiver operating characteristic curve (AUC), the calibration curve, and the clinical decision curve (decision curve analysis, DCA) were used to assess the discrimination, calibration, and level of clinical benefit obtained using the predictive models.ResultsWe studied 238 patients who were randomly allocated in a 7:3 ratio to a training group (n=166) and a test group (n=72). Univariate and multivariate logistic regression analyses were performed, in which three variables (the circulating parathyroid hormone (PTH) and Ca concentrations, and alkaline phosphatase (ALP) activity) were interrogated for possible roles as independent risk factors for hypocalcemia in patients with SHPT who undergo PTX, and used to construct predictive models. The AUCs for the constructed models were high for both the training (0.903) and test (0.948) groups. The calibration curve showed good agreement between the incidence of postoperative hypocalcemia estimated using the predictive model and the actual incidence. The DCA curve indicated that the predictive model performed well.ConclusionA predictive model constructed using a combination of preoperative PTH, Ca, and ALP may represent a useful means of identifying patients with SHPT at high risk of developing hypocalcemia following PTX in clinical practice.

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Treatment of Hyperparathyroidism (SHPT)

Cited by 4 publications

References 40 publications

Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Cost-effectiveness analysis of cinacalcet vs. paricalcitol in the treatment of hyperparathyroidism secondary to chronic kidney disease

Construction and validation of a predictive model for hypocalcemia after parathyroidectomy in patients with secondary hyperparathyroidism

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