Chemical Ablation of Recurrent and Persistent Secondary Hyperparathyroidism After Subtotal Parathyroidectomy

Chen, Han‐Hsiang; Lin, Cheng‐Jui; Wu, Chih‐Jen; Lai, Chuan-Tsai; Lin, Julia C.; Cheng, Shin-Ping; Yang, Tseng-Long

doi:10.1097/sla.0b013e318211ccc2

Cited by 47 publications

(29 citation statements)

References 24 publications

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“…This study included 28 patients on long‐term haemodialysis therapy with refractory SHPT who underwent PTX in the nephrology units at the Cardinal Tien Hospital and Tri‐Service General Hospital. Recurrent SHPT was defined as a serum iPTH level that had normalized (<300 pg/ml) within 6 months after the operation and then became elevated again after six postoperative months 16 . Two patients (7·1%; 2/28) were excluded from the analysis because of recurrent SHPT during the 12‐month follow‐up.…”

Section: Methodsmentioning

confidence: 99%

Bone turnover markers predict changes in bone mineral density after parathyroidectomy in patients with renal hyperparathyroidism

Lu¹,

Yu³

et al. 2012

Clinical Endocrinology

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Section: Methodsmentioning

confidence: 99%

Bone turnover markers predict changes in bone mineral density after parathyroidectomy in patients with renal hyperparathyroidism

Lu¹,

Yu³

et al. 2012

Clinical Endocrinology

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“…In patients with recurrent SHPT, the iPTH level normalizes (< 60 pg/ml) within 2 weeks after PTX, but becomes elevated again more than 6 months postoperatively (Yatsuka et al 2002;Chen et al 2011). Patients with SHPT were excluded from the current study.…”

Section: Patientsmentioning

confidence: 99%

Association between Increased Serum Osteoprotegerin Levels and Improvement in Bone Mineral Density after Parathyroidectomy in Hemodialysis Patients

Zheng

Chu

et al. 2012

Tohoku J. Exp. Med.

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Secondary hyperparathyroidism (SHPT) is a common complication in chronic renal disease. Osteoprotegerin (OPG), an extracellular cytokine receptor secreted by osteoblasts, can promote bone formation by inhibiting the function of osteoclasts. Hemodialysis (HD) patients have elevated serum OPG levels. OPG secretion can be suppressed with high parathyroid hormone (PTH) levels. HD patients with refractory SHPT can benefit from parathyroidectomy (PTX) treatment, but the changes of serum OPG, bone turnover markers and bone mineral density (BMD) following PTX in HD patients remain unclear. In this study, patients on maintenance HD who received PTX for refractory SHPT (n = 28) were prospectively followed for 1 year. Serum intact PTH (iPTH), alkaline phosphatase (Alk-P), and OPG were measured serially; BMD was measured pre-PTX and at 1 year after PTX. After PTX, serum iPTH levels reduced profoundly. Serum Alk-P levels increased rapidly, peaking at 2 weeks post-PTX, while serum OPG levels gradually increased at 2 weeks after PTX and peaked at 2 months. BMD improved in both femoral neck (FN; cancellous and cortical bone) and lumbar spine (LS; cancellous bone). Higher baseline iPTH levels were associated with greater FN and LS BMD improvements at one year after PTX. The increment of serum OPG was correlated with the increase in LS BMD, implying that inhibition of osteoclastic bone resorption may improve BMD within the first year after PTX. These findings suggest that PTX removes the suppressive effects of high PTH on OPG secretion, resulting in the increased serum OPG levels that may contribute to BMD improvement.

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“…Twenty sessions were performed to successfully manage 22 SHPT nodules. These nodules did not require any further treatments such as percutaneous ethanol injection therapy, high-intensity focused ultrasound or laser ablation [22,23,35]. There was a marked decrease in serum iPTH levels in all patients one day after MWA.…”

Section: Discussionmentioning

confidence: 78%

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study

Wei

Shao

et al. 2019

International Journal of Hyperthermia

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2019)Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility studyABSTRACT Objective: To assess the feasibility of microwave ablation (MWA) in treating ectopic secondary hyperparathyroidism (SHPT) in patients with chronic renal failure. Methods: In this retrospective study, MWA was used to manage 22 SHPT nodules in 20 patients. The laboratory test results, including intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase (ALP) levels; clinical symptoms; complications before, at one day after MWA, and at the end of follow-up were recorded and compared. Both echogenicity and size of SHPT nodules on ultrasound were documented before and after MWA. Results: iPTH levels decreased from 1106 ± 396 pg/mL to 264 ± 251 pg/mL (p < .001). Serum calcium and phosphorus levels decreased from 2.53 ± 0.21 mmol/L to 2.14 ± 0.25 mmol/L (p < .001) and from 1.96 ± 0.52 mmol/L to 1.76 ± 0.49 mmol/L (p < .05), respectively. There was no significant change in ALP levels across the different measurements (p ¼ .895). No significant differences were detected in iPTH, serum calcium and phosphorus levels, which were all in the normal range during the follow-up period (3-26 months, mean: 15.49 months) after MWA (p ¼ .186). The echogenicity of SHPT nodules changed from hypoechogenicity to uneven hyperechogenicity with a volume decrease in the majority of the nodules. Mild symptoms of Horner's syndrome occurred in one patient (5%), which improved during the follow-up period. A hematoma was encountered during ablation (5%). Hypocalcemia occurred in four patients one day after MWA (20%). No other complications were associated with MWA. Conclusion: MWA is a feasible option to treat ectopic SHPT nodules for destroying parathyroid gland tissue in ectopic SHPT with long-lasting clinical effects. ARTICLE HISTORY

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Chemical Ablation of Recurrent and Persistent Secondary Hyperparathyroidism After Subtotal Parathyroidectomy

Abstract: Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism.

Cited by 47 publications

References 24 publications

Bone turnover markers predict changes in bone mineral density after parathyroidectomy in patients with renal hyperparathyroidism

Bone turnover markers predict changes in bone mineral density after parathyroidectomy in patients with renal hyperparathyroidism

Association between Increased Serum Osteoprotegerin Levels and Improvement in Bone Mineral Density after Parathyroidectomy in Hemodialysis Patients

Efficacy and safety of microwave ablation for ectopic secondary hyperparathyroidism: a feasibility study

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