Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism

Tominaga, Yoshihiro; Tanaka, Yuji; Sato, Kesisuke; Nagasaka, Takaharu; Takagi, Hiroshi

doi:10.1002/(sici)1098-2388(199703/04)13:2<78::aid-ssu3>3.0.co;2-z

Cited by 193 publications

(121 citation statements)

References 50 publications

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“…When the glandular weight increases, the hyperplastic pattern is transformed from diffuse to nodular hyperplasia. If one gland exceeds 500 mg in weight, the gland almost always develops nodular hyperplasia (12). Based on these findings we hypothesised that in CKD patients polyclonal diffuse hyperplasia is transformed into nodular hyperplasia with several nodules, in which parathyroid cells proliferate monoclonally with a high growth potential (12)(13)(14)(15)(16).…”

Section: Pathogenesis Histopathology and Pathophysiology Of 2hptmentioning

confidence: 91%

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Surgical Treatment of Secondary Hyperparathyroidism due to Chronic Kidney Disease

Tominaga¹

2006

Upsala Journal of Medical Sciences

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Section: Pathogenesis Histopathology and Pathophysiology Of 2hptmentioning

confidence: 91%

“…This means that cells constituting nodules are resistant to calcitriol and hypercalcaemia. We therefore hypothesized that when at least one parathyroid gland progresses to nodular hyperplasia in patients with 2HPT, the patients may be refractory to medical treatment (12,18).…”

Section: Pathogenesis Histopathology and Pathophysiology Of 2hptmentioning

confidence: 99%

Surgical Treatment of Secondary Hyperparathyroidism due to Chronic Kidney Disease

Tominaga¹

2006

Upsala Journal of Medical Sciences

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“…Almost all parathyroid glands weighing more than 500 mg contain hyperplastic nodules [117,118] (EL 4). Unlike diffuse hyperplasia, these adenomatous nodules involute rarely after restored renal function and may cause persistent HPT even if only one gland appears morphologically enlarged (EL 4).…”

Section: Early Versus Late Parathyroidectomy In Tertiary (Post-renal mentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

104

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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“…4,7 There has been a trend to consider surgical intervention earlier in the course of SHPT, particularly if the estimated weight of a parathyroid gland exceeds 500 or 1000 mg (normal weight 30 to 40 mg), and thereby more likely to have nodular hyperplasia. 10 In addition, large glands that are detectable by ultrasound may be less likely to respond to medical treatment. 11 While the patient did not present with hypercalcemia, parathyroidectomy was considered the best treatment option because of progressive hyperparathyroid bone disease, persistently elevated PTH and phosphorus levels and unrelenting vitamin D deficiency.…”

Section: Discussionmentioning

confidence: 99%

Parathyroidectomy for Refractory Secondary Hyperparathyroidism with Severe Bone Disease

Evora

Mirasol

2012

JAFES

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Advances in the medical management of secondary hyperparathyroidism due to renal failure have decreased the use of parathyroidectomy as a treatment option. However, some patients with end-stage renal disease still progress to refractory hyperparathyroidism and debilitating bone disease, for which parathyroidectomy may be warranted. We describe a case of a 35-year-old female on chronic hemodialysis who presented with bone pains, deformities, decrease in height and recurrent pathologic fractures. She had markedly elevated parathyroid hormone (PTH), vitamin D deficiency, persistent hyperphosphatemia and hypocalcemia despite therapeutic measures. Subtotal parathyroidectomy was done with eventual improvement of biochemical abnormalities, resolution of bone pains and healing of fractures.

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Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism

Cited by 193 publications

References 50 publications

Surgical Treatment of Secondary Hyperparathyroidism due to Chronic Kidney Disease

Surgical Treatment of Secondary Hyperparathyroidism due to Chronic Kidney Disease

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Parathyroidectomy for Refractory Secondary Hyperparathyroidism with Severe Bone Disease

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