Initial Parathyroid Surgery in 606 Patients with Renal Hyperparathyroidism

Schneider, R.; Slater, Emily P.; Karakas, Elias; Bartsch, Detlef K.; Schlosser, Katja

doi:10.1007/s00268-011-1392-0

Cited by 91 publications

(136 citation statements)

References 102 publications

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“…The clinical significance of supernumerary glands and parathyroid cell rests detached from parathyroid glands is underscored by the fact that the majority of patients after TPTX and even after TPTX+BCT have measurable PTH levels after surgery [57,64,65] (EL 3). Thus, routine bilateral cervical thymectomy (BCT) is a continuous matter of debate in patients undergoing surgery for renal HPT.…”

Section: (El 3)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

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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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Section: (El 3)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

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104

130

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“…The indications for surgery have been mentioned above [7]. Blood samples were collected at the day before surgery, 15 min after resection of all parathyroid glands, and on the 3rd postoperative day.…”

Section: Methodsmentioning

confidence: 99%

“…Indications for surgery are intact PTH levels higher than 10 times the upper limit of normal. Patients with lower PTH levels (but still higher than 5 times the upper limit of normal) should be scheduled for PTX only in case of accompanying renal osteopathy, calciphylaxis, otherwise uncontrollable hypercalcemia, or progressive calcifications of vessels and soft tissues [7-10]. …”

Section: Introductionmentioning

confidence: 99%

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

et al. 2018

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Background: After parathyroidectomy (PTX), hungry bone syndrome leads to hypocalcemia due to bone remineralization. The aim of this pilot study was to analyze changes in markers of bone metabolism in patients with secondary hyperparathyroidism (sHPT) after PTX and to correlate these markers with bone pain measured with a validated questionnaire. Materials and Methods: All patients who underwent PTX for sHPT between March 2010 and February 2012 at out institution were included in this prospective observational pilot study. At the day before surgery and on the 3rd day thereafter, levels of parathyroid hormone (PTH), calcium, osteocalcin, alkaline phosphatase (AP), bone-specific AP (BAP), tartrate-resistant acid phosphatase 5b (TRAP5b), osteoprotegerin (OPG), sclerostin, fibroblast growth factor 23, and Klotho were measured. Additionally, all patients were requested to answer the Brief Pain Inventory preoperatively and on the 5th postoperative day. Results: A total of 35 patients with a mean age of 49.8 years were analyzed. A significant difference between the pre- and postoperative values could be detected in PTH, calcium, BAP, TRAP5b, and sclerostin. The highest correlation of laboratory markers with bone pain was found for preoperative PTH (r = 0.3), postoperative OPG (r = 0.4), postoperative BAP (r = –0.4), and postoperative Klotho (r = –0.4). Conclusions: The present study revealed significant perioperative changes in PTH, BAP, sclerostin, and TRAP5b after PTX. These markers may serve as laboratory markers to monitor bone metabolism in patients with sHPT. PTH, OPG, and sclerostin were the parameters with the closest correlation to bone pain. However, larger prospective trials with a longer follow-up are required to confirm these results.

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“…Coulston et al 24 en un estudio retrospectivo que incluyó a 115 pacientes con HPT renal tratados con PT sin autotrasplante, encontró una tasa de recurrencia de 12,2% con baja morbilidad asociada. Sin embargo, no existe consenso en la literatura sobre la opción quirúrgica preferente para el manejo del HPT asociado a IRC [20][21][22][25][26][27] . La PTH es un péptido de 84 aminoácidos con una vida media muy corta de 2 a 4 minutos.…”

Section: Discussionunclassified

Tratamiento quirúrgico del hiperparatiroidismo asociado a insuficiencia renal crónica: Experience in 71 patients

González

et al. 2015

Rev. méd. Chile

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Initial Parathyroid Surgery in 606 Patients with Renal Hyperparathyroidism

Abstract: Total parathyroidectomy with or without autotransplantation is a feasible and safe surgical procedure for patients on permanent dialysis with otherwise uncontrollable rHPT.

Cited by 91 publications

References 102 publications

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

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

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

Tratamiento quirúrgico del hiperparatiroidismo asociado a insuficiencia renal crónica: Experience in 71 patients

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