Four gland parathyroidectomy without reimplantation in patients with chronic renal failure

Saunders, R. N.; Karoo, R.O.S.; Metcalfe, Matthew S.; Nicholson, M. L.

doi:10.1136/pgmj.2004.026450

Cited by 42 publications

(77 citation statements)

References 18 publications

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“…Similarly, as described earlier by us and others [6,22,23,24], 13 patients (28%) had measurable iPTH levels within the normal range, and only 21/46 patients (46%) actually had iPTH levels below the normal range and were thus totally parathyroidectomized as intended. At the end of the follow-up time, we saw recurrent or persistent sHPT in 12 patients (26%).…”

Section: Discussionmentioning

confidence: 78%

“…Although there is some fear of adynamic bone disease in case of hypoparathyroidism and some resistance to constantly supplementing patients with active vitamin D postoperatively, tPTX without autotransplantation has found more followers during the last 5 years [22,23,24]. The procedure had already been suggested in the late 1980s and 1990s [6, 19,25,26,27,28].…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence of continued secretion of iPTH even after tPTX [6,22,23,24,25,26,27, 29], especially in patients remaining on dialysis rather than those being transplanted post-tPTX. Predisposing factors for continuing PTH secretion post-tPTX comprise duration of dialysis post-tPTX (reflecting the overall exposure to PTH stimulation) and no adequate drop of initial calcium levels after tPTX (possibly reflecting the adequacy of operative ablation of parathyroid glands) [29].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism

Stracke

Keller

Steinbach³

et al. 2009

Nephron Clin Pract

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In patients with chronic renal failure, secondary hyperparathyroidism (sHPT) is a common problem requiring surgical parathyroidectomy (PTX) if medical treatment with active vitamin D and calcimimetics fails. To minimize the risk for recurrence, we perform total PTX (tPTX) without autotransplantation. From October 1997 to January 2004, 46 patients (31 men and 15 women) underwent tPTX without autotransplantation (median age 51 years; range 19–80 years; median dialysis time before PTX 5 years; range 0–25 years). Indications for PTX were hyperparathyroid bone disease in 41 cases and calciphylaxis in 5 cases. Postoperatively, all patients were supplemented with vitamin D analogues, both calcitriol and cholecalciferol. Patients were followed up for 4–107 months (median 63 months). Although tPTX was intended in all cases, we saw recurrent or persistent hyperparathyroidism in 26% and supernumerary glands in 15% of cases. In 7 patients (15%), five or more glands were documented and in another four suspected confirming the clinical relevance of intraoperative parathyroid hormone (PTH) measurement. In our study, the positive predictive value of a low intraoperative PTH (<20 pg/ml) for a successful tPTX was 92%. 15 patients received a renal transplant after tPTX without autotransplantation. Here, an uncomplicated hypocalcaemia was noted in 3 patients. Last available calcium levels were between 1.72 and 2.66 mmol/l (median 2.35 mmol/l). After follow-up, active vitamin D was given in a median daily dose of 0.5 μg calcitriol (range 0–2.5 μg/day). There was no evidence of clinical bone disease and no pathological fractures after tPTX after a median observation period of 63 months. tPTX still offers the highest percentage of cure for sHPT, it is safe and postoperatively easily manageable. It allows for adequate supplementation with active vitamin D, and it is the most cost-effective procedure. It should be reconsidered an option for the treatment of sHPT.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism

Stracke

Keller

Steinbach³

et al. 2009

Nephron Clin Pract

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“…Follow-up PTH data for at least 6 months were available in 22 patients. Ninety-one percent of these patients had persistent hypoparathyroidism (6.4 pg/ml [1.8–27.4]) at last follow-up, which was 21 [16,17,18,19,20,21,22,23,24,25,26,27] months after surgery. Recurrent hyperparathyroidism was present in 2 cases.…”

Section: Resultsmentioning

confidence: 99%

Calcium Requirements after Parathyroidectomy in Patients with Refractory Secondary Hyperparathyroidism

Viaene

Evenepoel²,

Bammens³

et al. 2008

Nephron Clin Pract

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Background/Aims: Calcium supplements are often required following successful parathyroidectomy (PTX) in order to prevent overt hypocalcemia. The current study aims to quantify these calcium needs and to identify predictors of a high calcium need present at the time of surgery. Methods: Charts of 42 patients with chronic kidney disease stage 5D, who underwent a successful subtotal PTX, were reviewed in detail. Biochemical indices of mineral metabolism available within a time frame of 4 weeks before and 6 weeks after the surgery were registered. Details concerning active vitamin D (1-α-calcidiol and calcitriol) and calcium supplementation were recorded as well. Results: Serum calcium, phosphorus and PTH levels declined whereas total alkaline phosphatase levels increased significantly in the early post-PTX period. Transient hypocalcemia was observed in 83% of the patients. The median daily postoperative elemental calcium requirements amounted to 3.2 g during week 1, and declined to 2.4 g during week 6. A high preoperative PTH level and a low serum calcium level were identified as independent predictors of a high postoperative calcium need. Conclusion: Substantial amounts of elemental calcium are required following successful subtotal PTX in order to avoid frank hypocalcemia, especially in patients with a high PTH level and a low calcium level before surgery.

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“…José Antonio Amondarain . Fernando Vidaur abdominal [6] or pre-sternal [7] and TPT without transplantation advocated by some authors for dialysis patients non candidates for renal transplantation [3,8].…”

Section: Original Articlementioning

confidence: 99%

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

Echenique-Elizondo

Díaz-Aguirregoitia

Amondarain³

et al. 2008

Indian J Surg

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Background In the setting of total parathyroidectomy and autotransplantation surgery (TPTxAS) treatment for secondary hyperparathyroidism (SHPT) we evaluated whether intraoperative parathyroid hormone (iPTH) monitoring is an useful tool as a reference for total parathyroid removal.Design Prospective open single value measurement effi cacy study of one intraoperative (i.o.) diagnostic monitoring method (iPTH ) on a cohort of surgical patients. Main outcome measures Serum levels of iPTH during surgery and prediction time of the of descent of PTH levels (measured in the clinic, at admission day and intra-operatively during induction of anesthesia, and every 5 and 10 minutes after removal of adenoma and 24 hours thereafter) were analyzed. PatientsResults iPTH levels dropped clearly at ten minutes in all 35 patients and were non-measurable at 24 hours. iPTH decreased from pathological (1302.24 + 424.9 pg/ml) to half (50%) the values at the third intra-operative determination -minute 10 - (614.8 ± 196.62) and was undetectable at 24 hours.Conclusions Intra-operative measurement of iPTH is useful in the prediction of complete removal of all parathyroid tissue prior to autotransplantation thus avoiding persistence because of incomplete surgery.

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Four gland parathyroidectomy without reimplantation in patients with chronic renal failure

Cited by 42 publications

References 18 publications

Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism

Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism

Calcium Requirements after Parathyroidectomy in Patients with Refractory Secondary Hyperparathyroidism

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

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