How complete is a total parathyroidectomy in uraemia?

Farrington, Ken; Varghese, Zac; Chan, Man K.; Fernando, O. N.; Baillod, R. A.; Sweny, P.; Moorheàd, J. F.

doi:10.1136/bmj.294.6574.743

Cited by 27 publications

(18 citation statements)

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“…This possible advantage is clearly not always the case because of undesirable malignantlike spreading growth of the transplanted tissue [18]. In accordance with reports in the literature, patients with recurrent HPT at our institution have been seen to undergo difficult and partly unsuccessful reexploration after autografting [16,22,23,24]. Alternatively, some authors favor subcutaneous parathyroid autografting because the procedure is simple and reliable.…”

Section: Different Complications After Different Proceduressupporting

confidence: 74%

Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism

Ockert

Willeke

Richter

et al. 2002

Langenbeck's Archives of Surgery

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Section: Different Complications After Different Proceduressupporting

confidence: 74%

Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism

Ockert

Willeke

Richter

et al. 2002

Langenbeck's Archives of Surgery

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“…Although there is some fear of adynamic bone disease in case of hypoparathyroidism and some resistance to constantly supplementing patients with active vitamin D postoperatively, tPTX without autotransplantation has found more followers during the last 5 years [22,23,24]. The procedure had already been suggested in the late 1980s and 1990s [6, 19,25,26,27,28]. In these centers, tPTX without autotransplantation (and mostly also without routine thymectomy) has been proven a useful and in the short and mid-term an easily manageable operative approach for end-stage renal failure patients with severe sHPT.…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence of continued secretion of iPTH even after tPTX [6,22,23,24,25,26,27, 29], especially in patients remaining on dialysis rather than those being transplanted post-tPTX. Predisposing factors for continuing PTH secretion post-tPTX comprise duration of dialysis post-tPTX (reflecting the overall exposure to PTH stimulation) and no adequate drop of initial calcium levels after tPTX (possibly reflecting the adequacy of operative ablation of parathyroid glands) [29].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism

Stracke

Keller

Steinbach³

et al. 2009

Nephron Clin Pract

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In patients with chronic renal failure, secondary hyperparathyroidism (sHPT) is a common problem requiring surgical parathyroidectomy (PTX) if medical treatment with active vitamin D and calcimimetics fails. To minimize the risk for recurrence, we perform total PTX (tPTX) without autotransplantation. From October 1997 to January 2004, 46 patients (31 men and 15 women) underwent tPTX without autotransplantation (median age 51 years; range 19–80 years; median dialysis time before PTX 5 years; range 0–25 years). Indications for PTX were hyperparathyroid bone disease in 41 cases and calciphylaxis in 5 cases. Postoperatively, all patients were supplemented with vitamin D analogues, both calcitriol and cholecalciferol. Patients were followed up for 4–107 months (median 63 months). Although tPTX was intended in all cases, we saw recurrent or persistent hyperparathyroidism in 26% and supernumerary glands in 15% of cases. In 7 patients (15%), five or more glands were documented and in another four suspected confirming the clinical relevance of intraoperative parathyroid hormone (PTH) measurement. In our study, the positive predictive value of a low intraoperative PTH (<20 pg/ml) for a successful tPTX was 92%. 15 patients received a renal transplant after tPTX without autotransplantation. Here, an uncomplicated hypocalcaemia was noted in 3 patients. Last available calcium levels were between 1.72 and 2.66 mmol/l (median 2.35 mmol/l). After follow-up, active vitamin D was given in a median daily dose of 0.5 μg calcitriol (range 0–2.5 μg/day). There was no evidence of clinical bone disease and no pathological fractures after tPTX after a median observation period of 63 months. tPTX still offers the highest percentage of cure for sHPT, it is safe and postoperatively easily manageable. It allows for adequate supplementation with active vitamin D, and it is the most cost-effective procedure. It should be reconsidered an option for the treatment of sHPT.

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“…As in our cases, his patients only required a long term supplementation of calcium, none of them had undetectable PTH concentrations. Furthermore, Far rington [27] reported on 6-9 years of follow-up in 7 patients with end-stage renal disease treated by total PTX alone. Only in 1 of these patients PTH was unde tectable.…”

Section: Casementioning

confidence: 99%

Fulminant Calcinosis in Two Patients after Kidney Transplantation

Wenzel-Seifert¹,

Harwig²,

Keller³

1991

Am J Nephrol

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The first patient had total parathyroidectomy (PTX) with autografting 2 years before. She developed disabling soft-tissue calcifications following kidney transplantation. After reduction of the autograft – a complete removal was not possible – the subcutanous calcifications regressed. In the second patient, fulminant necrotizing vascular calcinosis developed after successful renal transplantation. Total PTX without autotransplantation was carried out, and progression of the vascular disease was ceased. In both patients, the parathyroid hormone was elevated but not the calcium-phosphate product. We suggest that fulminant calcinosis in patients with kidney transplants requires PTX.

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How complete is a total parathyroidectomy in uraemia?

Abstract: 2 Ogg CS. Total parathyroidectomy in the treatment of secondary (renal) hyperparathyroidism.

Cited by 27 publications

References 1 publication

Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism

Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism

Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism

Fulminant Calcinosis in Two Patients after Kidney Transplantation

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