Dynamics of Parathyroid Hormone Secretion After Total Parathyroidectomy and Autotransplantation

Conti-Freitas, Luiz Carlos; Foss‐Freitas, Maria Cristina; Lucca, Leandro Júnior; Costa, José Abrão Cardeal da; Mamede, Rui Celso Martins; Foss, Milton César

doi:10.1007/s00268-009-0057-8

Cited by 19 publications

(19 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Substantial decreases in serum phosphorus levels have been observed in patients who undergo parathyroidectomy for advanced SHPT [28-30]. It is common to see decreases in the early postoperative period, with sustained improvement in phosphorus control thereafter.…”

Section: Discussionmentioning

confidence: 99%

Is serum phosphorus control related to parathyroid hormone control in dialysis patients with secondary hyperparathyroidism?

et al. 2012

View full text Add to dashboard Cite

BackgroundElevated serum phosphorus (P) levels have been linked to increased morbidity and mortality in dialysis patients with secondary hyperparathyroidism (SHPT) but may be difficult to control if parathyroid hormone (PTH) is persistently elevated. We conducted a post hoc analysis of data from an earlier interventional study (OPTIMA) to explore the relationship between PTH control and serum P.MethodsThe OPTIMA study randomized dialysis patients with intact PTH (iPTH) 300–799 pg/mL to receive conventional care alone (vitamin D and/or phosphate binders [PB]; n = 184) or a cinacalcet-based regimen (n = 368). For patients randomized to conventional care, investigators were allowed flexibility in using a non-cinacalcet regimen (with no specific criteria for vitamin D analogue dosage) to attain KDOQI™ targets for iPTH, P, Ca and Ca x P. For those assigned to the cinacalcet-based regimen, dosages of cinacalcet, vitamin D sterols, and PB were optimized over the first 16 weeks of the study, using a predefined treatment algorithm. The present analysis examined achievement of serum P targets (≤4.5 and ≤5.5 mg/dL) in relation to achievement of iPTH ≤300 pg/mL during the efficacy assessment phase (EAP; weeks 17–23).ResultsPatients who achieved iPTH ≤ 300 pg/mL (or a reduction of ≥30% from baseline) were more likely to achieve serum P targets than those who did not, regardless of treatment group. Of those who did achieve iPTH ≤ 300 pg/mL, 43% achieved P ≤4.5 mg/dL and 70% achieved P ≤5.5 mg/dL, versus 21% and 46% of those who did not achieve iPTH ≤ 300 pg/mL. Doses of PB tended to be higher in patients not achieving serum P targets. Patients receiving cinacalcet were more likely to achieve iPTH ≤300 pg/mL than those receiving conventional care (73% vs 23% of patients). Logistic regression analysis identified lower baseline P, no PB use at baseline and cinacalcet treatment to be predictors of achieving P ≤4.5 mg/dL during EAP in patients above this threshold at baseline.ConclusionsThis post hoc analysis found that control of serum P in dialysis patients was better when serum PTH levels were lowered effectively, regardless of treatment received.Trial registrationClinicaltrials.gov identifier NCT00110890

show abstract

Section: Discussionmentioning

confidence: 99%

Is serum phosphorus control related to parathyroid hormone control in dialysis patients with secondary hyperparathyroidism?

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The ultimate treatment for persistent HPT-II in the two c u r r e n t p a t i e n t s w a s p a r a t h y r o i d e c t o m y w i t h autotransplantation, which involves the transplantation of a small amount of parathyroid tissue into the forearm, aiming to maintain normal parathyroid function. If recurrent hyperparathyroidism occurs, this technique allows a simple access, with locoregional anesthesia, for removal of the fragments from the forearm [23].…”

mentioning

confidence: 99%

Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease

Lopes

Albuquerque

Germano

et al. 2015

Oral Maxillofac Surg

View full text Add to dashboard Cite

Renal osteodystrophy (ROD) is the bone pathology that occurs as an uncommon complication related to the several alterations in mineral metabolism present in patients with chronic kidney disease (CKD). This paper describes two cases of severe ROD affecting the maxilla and mandible and causing facial disfigurement of a young and a middle-aged female patient with CKD. Both patients had a history of secondary hyperparathyroidism, previously treated by surgery. The pathogenesis of the disease, as well as its clinical, imaging, and histopathological features, and management of the patient are discussed.

show abstract

“…No HC-FMUSP, a recidiva do HPT no enxerto foi de 15,8% (3). Em alguns pacientes, o tecido enxertado parece ter comportamento variável e diferente do normal nas condições de hipercalcemia e hipocalcemia, refletindo sua autonomia (55).…”

Section: Discussionunclassified

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

Magnabosco

Tavares

Montenegro

2014

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

RESUMOO hiperparatireoidismo (HPT) secundário tem prevalência elevada em doentes renais crônicos. Decorre de alterações na homeostase mineral, principalmente do cálcio, que estimulam as glându-las paratireoides, com aumento na secreção de paratormônio (PTH). O estímulo prolongado pode levar à autonomia na função paratireóidea. Inicialmente, o tratamento é clínico, mas a paratireoidectomia (PTx) pode ser necessária. A PTx pode ser total, subtotal e total seguida de autoimplante de tecido paratireóideo. Este trabalho compara as indicações e resultados dessas técnicas na literatura. Foi realizada revisão sistematizada dos trabalhos publicados entre janeiro de 2008 e março de 2014 sobre tratamento cirúrgico do hiperparatireoidismo secundário nas bases de dados MedLine e LILACS. Foram utilizados os termos: hiperparatireoidismo; hiperparatireoidismo secundário; glândulas paratireoides e paratireoidectomia. Foram restritos a pesquisas apenas em humanos; artigos disponíveis em meio eletrônico; publicados em português, espanhol, inglês ou francês. A amostra final foi constituída de 49 artigos. A PTx subtotal e a total mais autoimplante foram as técnicas mais utilizadas, sem consenso sobre a técnica mais efetiva. Embora haja certa preferência pela última, a escolha depende da experiência do cirurgião. Há consenso sobre a necessidade de identificar todas as paratireoides e sobre a criopreservação de tecido paratireóideo, quando possí-vel, para enxerto em caso de hipoparatireoidismo. Exames de imagem podem ser úteis, especialmente nas recidivas. Tratamentos alternativos do HPT secundário, tanto intervencionistas quanto conservadores, carecem de estudos mais aprofundados. Arq Bras Endocrinol Metab. 2014;58(5):562-71 Descritores Hiperparatireoidismo; hiperparatireoidismo secundário; glândulas paratireoides; paratireoidectomia ABSTRACT Secondary hyperparathyroidism (HPT) has a high prevalence in renal patients. Secondary HPT results from disturbances in mineral homeostasis, particularly calcium, which stimulates the parathyroid glands, increasing the secretion of parathyroid hormone (PTH). Prolonged stimulation can lead to autonomy in parathyroid function. Initial treatment is clinical, but parathyroidectomy (PTx) may be required. PTx can be subtotal or total followed or not followed by parathyroid tissue autograft. We compared the indications and results of these strategies as shown in the literature through a systematic literature review on surgical treatment of secondary HPT presented in MedLine and LILACS from January 2008 to March 2014. The search terms were: hyperparathyroidism; secondary hyperparathyroidism; parathyroidectomy and parathyroid glands, restricted to research only in humans, articles available in electronic media, published in Portuguese, Spanish, English or French. We selected 49 articles. Subtotal and total PTx followed by parathyroid tissue autograft were the most used techniques, without consensus on the most effective surgical procedure, although there was a preference for the latter. The choice depend...

show abstract

Dynamics of Parathyroid Hormone Secretion After Total Parathyroidectomy and Autotransplantation

Cited by 19 publications

References 22 publications

Is serum phosphorus control related to parathyroid hormone control in dialysis patients with secondary hyperparathyroidism?

Is serum phosphorus control related to parathyroid hormone control in dialysis patients with secondary hyperparathyroidism?

Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease

Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura

Contact Info

Product

Resources

About