Medical and Surgical Treatment for Secondary and Tertiary Hyperparathyroidism

Schlosser, Katja; Zielke, A.; Rothmund, M.

doi:10.1177/145749690409300407

Cited by 38 publications

(27 citation statements)

References 66 publications

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“…tHPT can cause serious problems, including hypercalcaemia, osteitis fibrosa cystica, osteoporosis leading to increased risk of fracture, soft tissue calcification, bone pain, myopathy with muscular weakness, tendon rupture, anaemia (refractory to erythropoietin), arterial hypertension, and hypercalciuria that increases the risk of kidney stone disease, which is particularly deleterious in a renal graft [4,[6][7][8][9][10][11][12].…”

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confidence: 99%

Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

et al. 2011

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TerTiary hyperparathyroidism (tHPT) can develop after any long-standing period of hypocalcemia, such as those seen with chronic dialysis or gastrointestinal malabsorption; however, tHPT occurs most commonly in the setting of kidney transplantation (KTX), whereby patients with secondary HPT continue to have elevated parathyroid hormone (PTH) levels after KTX. tHPT has been reported in up to 50% of patients who underwent KTX [1, 2] and its occurrence is thought to be related to severity of pretransplant HPT [3] and duration of dialysis prior to transplantation [1,4,5]. Tertiary hyperparathyroidism (tHPT) most commonly refers to a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient method for treatment of tHPT. In this study, we examined our 31-year experience with patients who underwent PTX for tHPT after KTX and assessed the effects of PTX on graft function according to the type of surgery. Among 2,981 recipients who underwent renal allograft between April 1979 and Dec. 2010, 15 patients (0.5%) were identified as having tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX for evaluation of the therapeutic effect, and glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation for investigation of any effect on graft function. One patient showed persistent hyperparathyroidism and hypercalcemia after limited PTX. We experienced 14 successful PTXs, including 3 total PTX with autotransplantations, 8 subtotal PTXs, and 3 limited PTXs. Levels of iPTH and serum calcium were at normal range after PTX. Estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. PTX can cure tHPT-specific symptoms and signs by recovery of hypercalcemia, but may carry the risk of deterioration of kidney graft function. We suspect that subtotal PTX, rather than total PTX with AT, prevent any risk of kidney graft deterioration in surgical treatment of tHPT, and, in selective tHPT patients, limited PTX might be recommended.

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Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

et al. 2011

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“…En relación a los síntomas, cuarenta y cuatro pacientes (75,9%) en el grupo de HPT 2° y 11 (85%) en el de HPT 3° debutaron con síntomas, siendo el más frecuente la presencia de alteraciones musculoesqueléticas. Diversos estudios evidencian la presencia de dolor óseo, debilidad muscular y prurito como los síntomas más frecuentes en este tipo de pacientes 7,14,15 . Las alteraciones óseas asociadas a HPT en pacientes con IRC se incluyen dentro del concepto de "osteodistrofia renal" 12,16 .…”

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

González

et al. 2015

Rev. méd. Chile

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“…Hungry bone syndrome may follow parathyroidectomy [46,47]. This condition is marked by extensive hypophosphataemia and hypocalcaemia, mostly refractory to oral supplementation [40][41][42][43][44][45][46][47]51].…”

Section: Discussionmentioning

confidence: 99%

“…Empirical oral vitamin D3 and oral calcium supplementation is usually satisfactory. Intravenous calcium is reserved for patients with severe symptomatic hypocalcaemia [44,45]. Symptomatic postoperative hypocalcaemia occurs in about 7% of patients on calcium supplementation.…”

Section: Discussionmentioning

confidence: 99%

Od preparowania czterogruczołowego do technik małoinwazyjnych. Małoinwazyjna paratyroidektomia jako obecny standard chirurgii pierwotnej nadczynności przytarczyc

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Proczko-Markuszewska

et al. 2014

Endokrynologia Polska

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Complete surgical resection of hyperfunctioning parathyriod tissue is essential for the treatment of primary hyperparathyroidism. During recent years, minimally invasive surgery has been successfully applied in neck exploration, because of significant developments of guidance by intraoperative scans, the use of quick, intraoperative PTH assay, and also preoperative imaging procedures such as highresolution ultrasonography and sestamibi scintigraphy. The results of operations which are performed with minimally invasive techniques are comparable to those of conventional surgery, and provide advantages with regard to cosmetic result, length of hospitalisation, and reduced post-operative pain. StreszczenieCałkowite chirurgiczne usunięcie nadczynnej tkanki gruczołowej jest kluczowe dla leczenia pierwotnej nadczynności przytarczyc. Podczas ostatnich lat, techniki chirurgii małoinwazyjnej były z sukcesem wprowadzane do preparowania tkanek szyi. Było to możliwe dzięki opracowaniu śródoperacyjnych metod lokalizowania zmienionej tkanki, szybkim testom oznaczającym stężenie PTH w surowiczy, jak również doskonaleniu technik obrazowania przedoperacyjnego, takich jak ultrasonografia wysokiej rozdzielczości czy scyntygrafia z wykorzystaniem sestamibi. Wyniki operacji z wykorzystaniem technik małoinwazyjnych są porównywalne z wynikami technik konwencjonalnych oraz wiążą się z zaletami, takimi jak skrócony okres hospitalizacji, zmniejszenie bólu pooperacyjnego czy lepszy efekt kosmetyczny. (Endokrynol Pol 2014; 65 (3): 240-249) Słowa kluczowe: pierwotna nadczynność przytarczyc; konwencjonalne preparowanie tkanek szyi; minimalnie inwazyjna parathyroidectomia

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Medical and Surgical Treatment for Secondary and Tertiary Hyperparathyroidism

Cited by 38 publications

References 66 publications

Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

Surgical treatment of tertiary hyperparathyroidism after renal transplantation: A 31-year experience in a single institution

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

Od preparowania czterogruczołowego do technik małoinwazyjnych. Małoinwazyjna paratyroidektomia jako obecny standard chirurgii pierwotnej nadczynności przytarczyc

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