Ectopic and supernumerary parathyroid glands in patients with refractory renal hyperparathyroidism

Reitz, Robert J.; Dreimiller, Angelina; Khil, Alina; Horwitz, Edward; McHenry, Christopher R.

doi:10.1016/j.surg.2020.08.007

Cited by 21 publications

(34 citation statements)

References 31 publications

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“…Permanent hypoparathyroidism is reported following surgery in up to 9.2% of patients with kidney-related HPT. 260,264,289,320,424,425 Higher rates are reported following total PTX with autotransplantation than after subtotal resection, although this data is not robust. 271,289,424 In patients with postkidney transplant disease, permanent hypoparathyroidism or hypocalcemia is reported in up to 10.0% of patients.…”

Section: Permanent Hypoparathyroidismmentioning

confidence: 96%

“…290 One study with a median follow-up of 6.6 years postoperatively reported a 40% risk of death, 258 while a second reported that 47% of patients died a mean of 70.7 months postoperatively. 320 When examining by surgical subtype, 2 studies have demonstrated no difference in the mortality rates following subtotal PTX versus total PTX with autotransplant, 257,258 or between total PTX with and without autotransplant. 286 Some of the deaths reported in single-institution studies are unrelated to the surgery, such as deaths secondary to lung cancer 429 or calciphylaxis.…”

Section: Mortalitymentioning

confidence: 99%

“…In the setting of kidney-related HPT, intrathymic parathyroid tissue will be affected by the same pathophysiologic process causing hyperplasia and therefore is a source for potential persistent or recurrent disease 319. Consequently, some surgeons perform bilateral transcervical thymectomy as a standard therapy accompanying either subtotal resection or total resection with autotransplantation 270,284,319–321. Other surgeons only perform transcervical thymectomy unilaterally if an ipsilateral gland cannot be located 260,298,322.…”

Section: Planning Of Surgerymentioning

confidence: 99%

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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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Objective: To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. Background: Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. Methods: Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. Results: These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. Conclusions: Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.

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Section: Permanent Hypoparathyroidismmentioning

confidence: 96%

Section: Mortalitymentioning

confidence: 99%

Section: Planning Of Surgerymentioning

confidence: 99%

See 1 more Smart Citation

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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“…The number of removed parathyroid glands in the MIVAP group did not differ from that in the conventional surgery study, confirming the feasibility of MIVAP for rHPT [ 21 , 25 ]. The number of approximately 3.5 in both groups corresponds to subtotal parathyroidectomy with transcervical thymus resection the best surgical strategy for patients currently listed for kidney transplantation [ 7 , 31 ]. The number of removed glands also plays an important role in predicting postoperative disease persistence and late recurrence of rHPT (see below) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…This agrees with the reported rates of 3.6–22% for rate of persistent rHPT postoperatively [ 33 – 36 ]. The most likely cause of rHPT persistence after surgery is the supernumerary or ectopic parathyroid gland [ 31 ]. The PTH levels at follow-up were significantly higher in the MIVAP group.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive video-assisted parathyroidectomy (MIVAP) versus conventional parathyroidectomy for renal hyperparathyroidism: a retrospective multicenter study

et al. 2022

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To compare minimally invasive video-assisted parathyroidectomy (MIVAP) versus conventional surgery for renal hyperparathyroidism (rHPT). Between 2006 and 2020, 53 patients underwent MIVAP and 182 underwent conventional parathyroidectomy for rHPT at the Kliniken Essen-Mitte and Knappschaftskrankenhaus Bochum, respectively. Two propensity score-matched groups were retrospectively analyzed: the MIVAP group (VG; n = 53) and the conventional group (CG; n = 53). To assess long-term results, the patients were questioned prospectively (VG; n = 17, and CG; n = 26). The VG had a smaller incision (2.8 vs. 4.8 cm), shorter operation duration (81.0 vs. 13.9 min), and shorter duration of stay (2.4 vs. 5.7 days) (p < 0.0001) but a smaller drop in parathyroid hormone (PTH) postoperatively (81.3 vs. 85.5%. p = 0.022) than the CG. The conversion rate was 9.4% (n = 5). The VG had better Patient Scar Assessment Scale (PSAS) scores (10.8 vs. 11.7 p = 0.001) but worse SF-12 health survey scores (38.7 vs. 45.8 for physical health and 46.7 vs. 53.4 for mental health) (p < 0.0001). The PTH level at follow-up was higher in the VG (162.7 vs. 59.1 ng/l, p < 0.0001). There were no differences in morbidity, number of removed parathyroid glands, disease persistence, late rHPT relapse and need for repeat surgery between groups. MIVAP was superior to conventional parathyroidectomy regarding aesthetic outcomes and cost effectiveness. Conventional surgery showed better control of PTH levels and health scores on follow-up than MIVAP, without any impact on rHPT relapse and need for repeat surgery.Trail registration number and date of registration: DRKS00022545 on 14.12.2020. Graphical abstract

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Renaler Hyperparathyreoidismus

Dotzenrath

2021

Springer Reference Medizin

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Ectopic and supernumerary parathyroid glands in patients with refractory renal hyperparathyroidism

Cited by 21 publications

References 31 publications

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Minimally invasive video-assisted parathyroidectomy (MIVAP) versus conventional parathyroidectomy for renal hyperparathyroidism: a retrospective multicenter study

Renaler Hyperparathyreoidismus

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