Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: Clinical and laboratory long-term follow-up

Puccini, Marco; Carpi, Angelo; Cupisti, Adamasco; Caprioli, Richard M.; Iacconi, Pietro; Barsotti, M; Buccianti, P; Mechanick, Jeffrey; Nicolini, Andrea; Miccoli, Paolo

doi:10.1016/j.biopha.2009.06.006

Cited by 39 publications

(40 citation statements)

References 15 publications

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“…Generally, remnant-conserving techniques are associated with good clinical outcome and functional improvement [6,[19][20][21]. Regardless of the surgical procedure we noted a rapid improvement of clinical symptoms after both types of parathyroidectomies, mainly those that concerned bone pains, pruritus, and muscle weakness.…”

Section: Discussionmentioning

confidence: 65%

“…The third technique, total parathyroidectomy without autotransplantation (tPtx), was initially severely criticised mainly for the long-term hypoparathyroidism induced and its consequences on bone metabolism [13]. Recent papers, however, have revived tPtx as a trustworthy technique with comparable results in short-and medium-term follow-up [6,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…Even if both techniques are now under intense criticism, mainly due to their high recurrence rates of sHPT, they remain the most recommended and widely performed surgical procedures [1,3]. Recently another technique, total parathyroidectomy without autotransplant (tPtx), re-emerged as a trustworthy surgical solution in severe sHPT, especially in patients with low perspective for renal transplantation [1,3,6].…”

Section: Introductionmentioning

confidence: 99%

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Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Neagoe

Mureşan

Voidăzan

et al. 2016

Endokrynologia Polska

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Introduction: The need for parathyroidectomy remains high in the group of patients on long-term dialysis with medically refractory secondary hyperparathyroidism (sHPT). We aim to compare the results after subtotal parathyroidectomies (sPtx) and total parathyroidectomies with autotransplant (tPtx + AT) performed for sHPT at a single referral centre. Material and methods:This prospective study comparatively analysed sPtx and tPtx + AT performed in our department between February 2010 and December 2014. We followed-up both surgical techniques, with respect to the main clinical symptoms, laboratory data, mortality, and recurrent disease. Results: Forty-three patients on whom we performed 26 sPtx and 19 tPtx + AT were entered in the study. There were no statistically significant differences between groups as far as demographic and preoperative clinical data are concerned. We did not encounter postoperative mortality in either of the groups. The follow-up period was significantly longer for the sPtx group (p = 0.04). The immediate postoperative serum calcium levels were significantly lower in the tPtx + AT group (p = 0.009). Definitive hypoparathyroidism was encountered in two patients in the sPtx group (8.3%) and in one from the tPtx + AT group (5.26%). Four patients from the sPtx group (16.6%) and three from the tPtx + AT group (15.78%) died during the follow-up due to causes unrelated to parathyroidectomy. Overall we had two recurrences in the sPtx group and none in the tPtx + AT group (p = 0.57).

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Neagoe

Mureşan

Voidăzan

et al. 2016

Endokrynologia Polska

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“…However, several serum bone markers are more conveniently used to measure changes in bone turnover (Malluche et al 2011). None of our patients had biochemical hypoparathyroidism, which was defined as iPTH levels < 20 pg/ml (Puccini et al 2010) at long-term follow up. However, we could not exclude the possibility of low turnover bone disease because the mean serum intact PTH of our sample was 48.1 ± 19.5 pg/ml 1 year after PTX (Goodman et al 1994;Yajima et al 2001).…”

Section: Biochemical Parameter Changes After Ptxmentioning

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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“…The most frequent pathology diagnosis in our series was nodular hyperplasia, a pattern which is considered to be involved in a higher disease recurrence rate (34,35); the short/medium time follow-up period did not allow us to draw any conclusion regarding this issue. Among our patients four (13.79%) were found to have unexpected thyroid pathology at the time of PTx, including two with differentiated thyroid carcinoma.…”

Section: Discussionmentioning

confidence: 74%

Parathyroidectomy in the treatment of secondary hyperparathyroidism. Clinical and laboratory outcomes/ Paratiroidectomia în tratamentul hiperparatiroidismului secundar. Aspecte clinice şi de laborator

Neagoe¹,

Sala²,

Ionela³

et al. 2014

Romanian Review of Laboratory Medicine

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Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: Clinical and laboratory long-term follow-up

Cited by 39 publications

References 15 publications

Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

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

Parathyroidectomy in the treatment of secondary hyperparathyroidism. Clinical and laboratory outcomes/ Paratiroidectomia în tratamentul hiperparatiroidismului secundar. Aspecte clinice şi de laborator

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