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Oikonomou P, Nikolaou C, Romanidis K, Pitiakoudis M, Kesisoglou I, Sapalidis K. A comparison of surgical treatments for tertiary hyperparathyroidism. A systematic review. Folia Med (Plovdiv) 2024; 66:155-160. [PMID: 38690809 DOI: 10.3897/folmed.66.e116202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/07/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Tertiary hyperparathyroidism develops in patients who have secondary hyperparathyroidism that persists despite successful kidney transplantation or in patients who are on chronic dialysis.
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Yue W, Jiang T, Ai Z, Deng E, Chai H, Li X, He H, Zhang Z, Weng N, Qin X, Fan J, Tang X, Heng W, Li Y, Sun L, Peng C, Xu H. US-guided Percutaneous Radiofrequency Ablation for Secondary Hyperparathyroidism: Long-term Outcomes and Prognostic Factors. Radiology 2024; 311:e231852. [PMID: 38625007 DOI: 10.1148/radiol.231852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Background Although favorable outcomes have been reported with radiofrequency ablation (RFA) for secondary hyperparathyroidism (SHPT), the long-term efficacy remains insufficiently investigated. Purpose To evaluate the long-term efficacy and safety of US-guided percutaneous RFA in patients with SHPT undergoing dialysis and to identify possible predictors associated with treatment failure. Materials and Methods This retrospective study included consecutive patients with SHPT with at least one enlarged parathyroid gland accessible for RFA who were undergoing dialysis at seven tertiary centers from May 2013 to July 2022. The primary end point was the proportion of patients with parathyroid hormone (PTH) levels less than or equal to 585 pg/mL at the end of follow-up. Secondary end points were the proportion of patients with normal calcium and phosphorus levels, the technical success rate, procedure-related complications, and improvement in self-rated hyperparathyroidism-related symptoms (0-3 ranking scale). The Wilcoxon signed rank test and generalized estimating equation model were used to evaluate treatment outcomes. Univariable and multivariable regression analyses identified variables associated with treatment failure (recurrent or persistent hyperparathyroidism). Results This study included 165 patients (median age, 51 years [IQR, 44-60 years]; 92 female) and 582 glands. RFA effectively reduced PTH, calcium, and phosphorus levels, with targeted ranges achieved in 78.2% (129 of 165), 72.7% (120 of 165), and 60.0% (99 of 165) of patients, respectively, at the end of follow-up (mean, 51 months). For the RFA sessions, the technical success rate was 100% (214 of 214). Median symptom scores (ostealgia, arthralgia, pruritus) decreased (all P < .001). Regarding complications, only hypocalcemia (45.8%, 98 of 214) was common. Treatment failure occurred in 36 patients (recurrent [n = 5] or persistent [n = 31] hyperparathyroidism). The only potential independent predictor of treatment failure was having less than four treated glands (odds ratio, 17.18; 95% CI: 4.34, 67.95; P < .001). Conclusion US-guided percutaneous RFA was effective and safe in the long term as a nonsurgical alternative for patients with SHPT undergoing dialysis; the only potential independent predictor of treatment failure was a lower number (<4) of treated glands. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Wenwen Yue
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Tingting Jiang
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Zisheng Ai
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Erya Deng
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Huihui Chai
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Xiaolong Li
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Hongfeng He
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Zhengxian Zhang
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Ning Weng
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Xiachuan Qin
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Jing Fan
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Xiaoqing Tang
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Wei Heng
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Yong Li
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Liping Sun
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Chengzhong Peng
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
| | - Huixiong Xu
- From the Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, No. 301 Yanchang Zhong Road, Jingan District, Shanghai 200072, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China (W.Y., T.J., E.D., H.C., L.S., C.P.); Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China (Z.A.); Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China (X.L., H.X.); Department of Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China (H.H.); Departments of Ultrasound (Z.Z.) and Nephrology (N.W.), Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China; Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China (X.Q.); Department of Ultrasound, Nanchong Central Hospital, North Sichuan Medical College, Nanchong, China (X.Q.); Department of Ultrasound, Yiwu Fuyuan Hospital, Yiwu, China (J.F., X.T.); and Departments of Ultrasound (W.H.) and Nephrology (Y.L.), The First People's Hospital of Aksu, Xinjiang, China
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Casella C, Guarneri C, Campanile M, Adhoute X, Gelera PP, Morandi R. Surgical treatment of tertiary hyperparathyroidism: does one fit for all? Front Endocrinol (Lausanne) 2023; 14:1226917. [PMID: 38027172 PMCID: PMC10652876 DOI: 10.3389/fendo.2023.1226917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Tertiary hyperparathyroidism (3HPT) is defined as a condition of excessive autonomous excretion of intact parathyroid hormone (iPTH) with persistent hypercalcemia (>10.5 mg/dL) that lasts for more than 12 months after a successful kidney transplantation, in the context of a long course secondary hyperparathyroidism (2HPT). The chronic high levels of iPTH cause a worsening of graft function, accompanied by systemic symptoms of hypercalcemia. The only curative therapy is parathyroidectomy (PTX). It remains unclear whether total parathyroidectomy with autotransplantation (TPTX-AT) or subtotal parathyroidectomy (SPTX) lead to better outcomes. Aims The aim of this retrospective, single-institution cohort study is to evaluate the rate of persistent or recurrent disease and postoperative calcium/iPTH disturbances in patients treated with TPTX-AT or SPTX for 3HPT. Methods A single-center retrospective analysis of 3HPT patients submitted to TPTX-AT or SPTX between 2007-2020 with at least 24 months follow-up was conducted. The outcome parameters included persistence/recurrence of disease, incidence of transitory hypocalcemia, and temporary/permanent hypoparathyroidism. Results A cohort of 52 patients was analyzed and divided in two groups: 38 (73%) were submitted for TPTX-AT, and 14 patients (27%) were submitted for SPTX. The TPTX-AT population showed lower plasmatic calcium concentrations compared with the SPTX group during the entire follow-up period (p<0.001). There were eight cases (21%) of transitory hypocalcemia in the TPTX-AT group and none in the SPTX group, with p=0.065. Two cases (5%) of temporary hypoparathyroidism occurred in the TPTX-AT group and none in the SPTX group, with p= 0.530. There were no cases of permanent hypoparathyroidism and no cases of persistent disease. No statistical difference was assessed for the recurrence of 3HPT between the TPTX-AT group and the SPTX group (N=1, 3% vs N=1, 7%) (p=0.470). Conclusion No significative difference was registered between the TPTX-AT and SPTX groups in terms of persistence/recurrence of disease, incidence of transitory hypocalcemia, and temporary/permanent hypoparathyroidism. Mean calcium levels iPTH values were statistically lower among the TPTX-AT group compared with the SPTX group while remaining always in the range of normality.
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Affiliation(s)
- Claudio Casella
- Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Claudio Guarneri
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Manuela Campanile
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Saint Joseph, Marseille, France
| | - Xavier Adhoute
- Service d’Hépato-Gastro-Entérologie, Hôpital Saint Joseph, Marseille, France
| | - Pier Paolo Gelera
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Riccardo Morandi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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Yu B, Li J, Lu C, Lu Q, Zhou Y, Luo Y. Ultrasound-guided microwave ablation for tertiary hyperparathyroidism in patients with renal transplantation. Int J Hyperthermia 2023; 40:2256497. [PMID: 37710400 DOI: 10.1080/02656736.2023.2256497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE To explore the safety and efficacy of ultrasound-guided microwave ablation (MWA) for tertiary hyperparathyroidism (THPT) in patients with renal transplantation (RT). METHODS In total, fifteen patients with THPT after renal transplantation who underwent MWA were enrolled in the study. The pre- and post-MWA intact parathyroid hormone (iPTH), serum calcium, phosphorus, creatinine, urea nitrogen and estimated glomerular filtration rate (eGFR) values were compared. RESULTS A total of 38 parathyroid hyperplastic nodules in 15 RT patients were treated with ultrasound-guided MWA. The mean (median, range) size of the hyperplastic parathyroid nodules was 11.5 mm (11 mm, 5-25 mm), and the average (median, range) ablation time was 163.5s (121 s, 44-406 s). The average levels of serum iPTH and calcium at 1 d, 7 d, 1 month, 3 months, 6 months, 1 year post-MWA and at the end of follow-up were significantly lower than those pre-MWA (all p < 0.05). Compared with the pre-MWA value (0.76 mmol/L), the serum phosphorus levels at 1 d post-MWA (0.63 mmol/L) were significantly decreased, and those at 7 d, 1 month, 3 months, 6 months, 1 year post-MWA and at the end of follow-up were significantly increased, but all were within the normal range. There was no significant difference in serum creatinine and eGFR pre-MWA and post-MWA. No major MWA-related complications occurred. CONCLUSION Ultrasound-guided MWA shows potential as a viable treatment for THPT in RT patients. However, further studies are required to confirm its safety and effectiveness in larger cohorts of longer duration.
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Affiliation(s)
- Boyang Yu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jiawu Li
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Chunyan Lu
- Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qiang Lu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yaxin Zhou
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism. Ann Surg 2022; 276:e141-e176. [PMID: 35848728 DOI: 10.1097/sla.0000000000005522] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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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Frey S, Goronflot T, Blanchard C, Kerleau C, Gourraud PA, Wargny M, Caillard C, Hourmant M, Figueres L, Mirallié É. Impact of parathyroidectomy on kidney graft function in post-transplant tertiary hyperparathyroidism: a comparative study. Langenbecks Arch Surg 2022; 407:2489-2498. [PMID: 35596781 DOI: 10.1007/s00423-022-02555-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Parathyroidectomy to treat tertiary hyperparathyroidism (THPT) is now on a par with calcimimetic treatment. The effects of cinacalcet and parathyroidectomy on kidney transplant function remain controversial. The aim of this study was to evaluate kidney transplant function in THPT patients treated either by parathyroidectomy, cinacalcet, or not treated. METHODS Between 2009 and 2019, 231 patients with functional grafts presenting THPT, defined either by calcaemia superior to 2.5 mmol/L with elevated PTH level or hypercalcaemia with non-adapted PTH level 1 year after kidney transplantation, were included. Hyperparathyroid patients treated by cinacalcet and parathyroidectomy were matched for age, sex, graft rank, and baseline eGFR with cinacalcet-only and untreated patients. Conditional logistic regression models were used to compare eGFR variations 1 year after parathyroidectomy between operated patients and matched controls. Five-year survivals were compared with the Mantel-Cox test. RESULTS Eleven patients treated with parathyroidectomy and cinacalcet were matched with 16 patients treated by cinacalcet-only and 29 untreated patients. Demographic characteristics were comparable between groups. Estimated odds ratios for eGFR evolution in operated patients compared with cinacalcet-only and untreated patients were 0.92 [95%CI 0.83-1.02] and 0.99 [0.89-1.10] respectively, indicating no significant impairment of eGFR 1 year after surgery. Five-year allograft survival was not significantly impaired in operated patients. CONCLUSIONS Parathyroidectomy did not appear to substantially alter or improve graft function 1 year after surgery or 5-year allograft survival. It could be hypothesized that in addition to its known benefits, parathyroidectomy can be safely performed vis-à-vis graft function in tertiary hyperparathyroidism.
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Affiliation(s)
- Samuel Frey
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L'Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France.,Université de Nantes, quai de Tourville, 44000, Nantes, France.,L'institut du Thorax, Unité Inserm UMR 1087 / CNRS UMR 6291, IRS 8 Quai Moncousu, 44000, Nantes, France
| | - Thomas Goronflot
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11, Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des données, Nantes, France
| | - Claire Blanchard
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L'Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France.,Université de Nantes, quai de Tourville, 44000, Nantes, France.,L'institut du Thorax, Unité Inserm UMR 1087 / CNRS UMR 6291, IRS 8 Quai Moncousu, 44000, Nantes, France
| | - Clarisse Kerleau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France
| | - Pierre-Antoine Gourraud
- Université de Nantes, quai de Tourville, 44000, Nantes, France.,CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11, Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des données, Nantes, France
| | - Matthieu Wargny
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11, Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des données, Nantes, France
| | - Cécile Caillard
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L'Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France
| | - Maryvonne Hourmant
- Université de Nantes, quai de Tourville, 44000, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France.,Service de Néphrologie-Immunologie Clinique, CHU de Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France
| | - Lucile Figueres
- Université de Nantes, quai de Tourville, 44000, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France.,Service de Néphrologie-Immunologie Clinique, CHU de Nantes, 30, boulevard Jean-Monnet, 44093, Nantes cedex, France
| | - Éric Mirallié
- Chirurgie Cancérologique, Digestive Et Endocrinienne, Institut Des Maladies de L'Appareil Digestif, Place Alexis Ricordeau, CHU Nantes, Hôtel Dieu, 44093, Nantes, CEDEX 1, France. .,Université de Nantes, quai de Tourville, 44000, Nantes, France.
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Lemoine S, Figueres L, Bacchetta J, Frey S, Dubourg L. Calcium homeostasis pathologies in hyperparathyroidism: nephrologic and endocrinologic points of view. ANNALES D'ENDOCRINOLOGIE 2022; 83:237-243. [DOI: 10.1016/j.ando.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Birsen O, Ozban M, Ozden A, Sungurtekin U, Erdem E, Kabay B, Yilmaz S, Aykota MR, Ozgen U, Demirci S, Aydin HC. Surgery for Secondary Hyperparathyroidism. Total or Subtotal? Indian J Surg 2022. [DOI: 10.1007/s12262-021-02821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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9
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Outcomes of Subtotal Parathyroidectomy Versus Total Parathyroidectomy With Autotransplantation for Tertiary Hyperparathyroidism: Multi-institutional Study. Ann Surg 2021; 274:674-679. [PMID: 34506323 DOI: 10.1097/sla.0000000000005059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Due to the paucity of data and controversy regarding the preferred surgical approach for managing tertiary HPT, we sought to investigate the outcomes of different surgical approaches in managing this challenging disease. METHODS We performed a multi-center retrospective study to include patients with tertiary HPT who underwent STPX or total parathyroidectomy with autotransplantation (TPX-A). RESULTS One hundred five patients had kidney transplant, and 43 were on dialysis. In the kidney transplant group, 61 patients underwent STPX, and 44 for TPX-A. Patients' demographics were not significantly different (48.61 ± 9.31 vs 47.95 ± 12.73 years, P = 0.759. The postoperative follow-up showed that the TPX-A cohort had a higher rate of hypoparathyroidism (N = 20, 45.45%) versus (N = 14, 22.95%) with the STPX cohort (P = 0.013). The cure among the TPX-A cohorts (84.09%) over the STPX cohort (73.77%) (P = 0.153). The long-term follow-up showed that the rate of developing temporary (N = 16, 41.03%) or permanent (N = 8, 20.51%) hypoparathyroidism was significantly higher among patients who underwent TPX-A over the patients who underwent STPX (N = 7, 17.95%), and (N = 4, 10.26%), respectively (P = 0.012). There was no statistical difference between the persistence (N = 3, 7.69%) or the recurrence (N = 2, 5.13%) of the HPT in the TPX-A cohort and the STPX cohort (N = 2, 5.13%). (N = 4, 10.26%), respectively, P = 0.644. CONCLUSIONS To our knowledge, this is the largest multi-center study that compared different approaches for managing tertiary HPT. Showing that STPX is the better modality in patients diagnosed with tertiary HPT and had kidney transplants avoiding the risk of hypoparathyroidism.
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10
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Frey S, Goronflot T, Kerleau C, Gourraud PA, Caillard C, Hourmant M, Mirallié É, Figueres L. Parathyroidectomy or cinacalcet: Do we still not know the best option for graft function in kidney-transplanted patients? A meta-analysis. Surgery 2021; 170:727-735. [PMID: 33810851 DOI: 10.1016/j.surg.2021.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 01/15/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tertiary hyperparathyroidism occurs in 25% to 50% of kidney-transplanted patients. Indication of parathyroidectomy is now discussed, since the calcimimetic agent, cinacalcet, is an alternate option. The effects of either of these treatments on graft function remain controversial, studied only in small cohorts showing either decrease or absence of modification. We performed a meta-analysis to evaluate the evolution of graft function after surgical or medical treatment. METHODS Studies assessing graft function in tertiary hyperparathyroidism after parathyroidectomy or cinacalcet introduction were enrolled into quantitative analysis using Pubmed, Embase, and Cochrane databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. Among 68 screened studies, 18 had no missing data and were included for statistical analyses. We performed random effect meta-analysis to determine changes in serum creatinine and estimated glomerular filtration rate. RESULTS Seven studies assessing the evolution of graft function 6 and/or 12 months after parathyroidectomy and 13 after administration of cinacalcet were included. Meta-analysis found no significant variations after parathyroidectomy in serum creatinine (6 studies, 314 patients) and estimated glomerular filtration rate (2 studies, 105 patients). No significant variation was found after administration of cinacalcet in serum creatinine (10 studies, 404 patients) and estimated glomerular filtration rate (6 studies, 149 patients). A significant heterogeneity between the studies (P < .01, Cochran's Q) was found. CONCLUSION Meta-analysis shows that parathyroidectomy and cinacalcet do not significantly impair graft function in patients with tertiary hyperparathyroidism. However, the significant heterogeneity between selected studies, partially explained by the lack of consensual definition of tertiary hyperparathyroidism, limits the conclusions of all previously published series.
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Affiliation(s)
- Samuel Frey
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, France; Université de Nantes, France
| | - Thomas Goronflot
- CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des Données, France
| | - Clarisse Kerleau
- Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, France
| | - Pierre-Antoine Gourraud
- Université de Nantes, France; CHU de Nantes, INSERM, CIC 1413, Pôle Hospitalo-Universitaire 11: Santé Publique, Santé au Travail, Pharmacie, Stérilisation, Clinique des Données, France
| | - Cécile Caillard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, France
| | - Maryvonne Hourmant
- Université de Nantes, France; Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, France; Service de néphrologie-immunologie clinique, CHU de Nantes, France
| | - Éric Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des maladies de l'Appareil Digestif, Hôtel Dieu, CHU Nantes, France; Université de Nantes, France
| | - Lucile Figueres
- Université de Nantes, France; Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, France; Service de néphrologie-immunologie clinique, CHU de Nantes, France.
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Belli M, Martin RM, Brescia MDG, Nascimento CP, Massoni Neto LM, Arap SS, Ferraz-de-Souza B, Moyses RMA, Peacock M, Montenegro FLDM. Acute and long-term kidney function after parathyroidectomy for primary hyperparathyroidism. PLoS One 2020; 15:e0244162. [PMID: 33382714 PMCID: PMC7774859 DOI: 10.1371/journal.pone.0244162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background In kidney transplant patients, parathyroidectomy is associated with an acute decrease in renal function. Acute and chronic effects of parathyroidectomy on renal function have not been extensively studied in primary hyperparathyroidism (PHPT). Methods This retrospective cohort study included 494 patients undergoing parathyroidectomy for PHPT. Acute renal changes were evaluated daily until day 4 post-parathyroidectomy and were stratified according to acute kidney injury (AKI) criteria. Biochemical assessment included serum creatinine, total and ionized calcium, parathyroid hormone (PTH), and 25-hydroxyvitamin D (25OHD). The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. We compared preoperative and postoperative renal function up to 5 years of follow-up. Results A total of 391 (79.1%) patients were female, and 422 (85.4%) were non-African American. The median age was 58 years old. The median (first and third quartiles) preoperative serum creatinine, PTH and total calcium levels were 0.81 mg/dL (0.68–1.01), 154.5 pg/mL (106–238.5), and 10.9 mg/dL (10.3–11.5), respectively. The median (first and third quartiles) preoperative eGFR was 86 mL/min/1.73 m2 (65–101.3). After surgery, the median acute decrease in the eGFR was 21 mL/min/1.73 m2 (p<0.0001). Acutely, 41.1% of patients developed stage 1 AKI, 5.9% developed stage 2 AKI, and 1.8% developed stage 3 AKI. The acute eGFR decrease (%) was correlated with age and PTH, calcium and preoperative creatinine levels in univariate analysis. Multivariate analysis showed that the acute change was related to age and preoperative values of ionized calcium, phosphorus and creatinine. The change at 12 months was related to sex, preoperative creatinine and 25OHD. Permanent reduction in the eGFR occurred in 60.7% of patients after an acute episode. Conclusion There was significant acute impairment in renal function after parathyroidectomy for PHPT, and almost half of the patients met the criteria for AKI. Significant eGFR recovery was observed during the first month after surgery, but a small permanent reduction may occur. Patients treated for PHPT seemed to present with prominent renal dysfunction compared to patients who underwent thyroidectomy.
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Affiliation(s)
- Marcelo Belli
- Division of Head and Neck Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
- * E-mail:
| | - Regina Matsunaga Martin
- Divison of Endocrinology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | | | - Climério Pereira Nascimento
- Division of Head and Neck Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Ledo Mazzei Massoni Neto
- Division of Head and Neck Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Sergio Samir Arap
- Division of Head and Neck Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Bruno Ferraz-de-Souza
- Divison of Nephrology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Rosa Maria Affonso Moyses
- Divison of Nephrology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
| | - Munro Peacock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Fábio Luiz de Menezes Montenegro
- Division of Head and Neck Surgery, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil
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12
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Influence of Parathyroidectomy on Kidney Graft Function in Secondary and Tertiary Hyperparathyroidism. Transplant Proc 2020; 52:3134-3143. [PMID: 32402458 DOI: 10.1016/j.transproceed.2020.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/20/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Timing of parathyroidectomy (PTX) remains controversial in candidates for kidney transplant with concomitant renal hyperparathyroidism (HPT). The aim of this retrospective study was to identify the influence of early vs late posttransplant PTX compared to pretransplant PTX on renal graft function and morbidity. METHODS This single-center cohort study includes 57 patients with renal HPT and kidney transplantation treated between 2007 and 2017. Ninety-six patients had surgery for renal HPT between 2007 and 2017 as a consecutive sample. Group 1 (n = 30; tertiary HPT), group 2 (n = 66; secondary HPT). Of group 1, 4 patients were excluded for PTX before and after kidney transplantation. In group 2, 20 patients were excluded since they had not undergone kidney transplantation during follow-up. Twelve patients were excluded because of short follow-up (kidney transplantation in 2018), and 3 patients were excluded because of transplant failure within 90 days. Twenty-six patients underwent posttransplant PTX (10 patients within 12 months after transplant), and 31 patients had undergone PTX prior to kidney transplantation. Graft function, serum calcium concentrations, parathyroid hormone (PTH) levels, postoperative morbidity, and 90-day mortality were recorded. RESULTS Median age was 53.1 years in group 1 and 49.1 years in group 2. Most patients were male (53.8% in group 1; 54.8% in group 2). Median preoperative PTH levels were significantly different with 331.6 pg/mL in group 1 and 667.5 pg/mL in group 2 (P = .003). Creatinine levels changed little from 1.4 mg/dL (range, 0.8-2.5) to 1.7 mg/dL (range, 0.7-7.3) in group 1, and no difference was seen between early or late PTX after transplantation. In group 2, creatinine levels were 8.5 mg/dL (range, 4.6-11.7) before PTX and 8.7 mg/dL (range, 5.1-11.9) after PTX. We saw no correlation between postoperative PTH and kidney function. Thirty-five patients with postoperative PTH < 15 pg/mL displayed a mean postoperative creatinine of 5.5 mg/dL (range, 4.3-6.8), similar to other patients. Both the 30-day and 90-day mortality rates were zero. CONCLUSIONS PTX had no negative effect on graft function, whether performed before or after (early or late) kidney transplantation. Surgical cure of renal HPT should be performed as soon as possible to prevent secondary complications and can also be safely carried out early after transplantation.
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Burgstaller T, Selberherr A, Brammen L, Scheuba C, Kaczirek K, Riss P. How radical is total parathyroidectomy in patients with renal hyperparathyroidism? Langenbecks Arch Surg 2018; 403:1007-1013. [PMID: 30519885 PMCID: PMC6328515 DOI: 10.1007/s00423-018-1739-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022]
Abstract
Purpose Total parathyroidectomy (tPTX) in patients with renal hyperparathyroidism (RHPT) aims at the complete removal of all hyperfunctioning parathyroid tissue. Whenever parathyroidectomy is termed “total,” undetectable postoperative parathyroid hormone (PTH) levels within the first postoperative week are expected. The aim of this study was to evaluate if tPTX is technically possible using a radical surgical procedure. Methods In 109 consecutive patients with RHPT (on hemodialysis: n = 50; after kidney grafting n = 59), removal of all visible parathyroid tissue, bilateral thymectomy, bilateral central neck dissection (level VI), and immediate autotransplantation (AT) was performed. Intact PTH (iPTH) levels were measured in the first postoperative week. PTX was classified “total” when iPTH dropped below 10 pg/ml, “subtotal” between 10 and 65 pg/ml, and “insufficient” where levels stayed above 65 pg/ml. Results According to the postoperative PTH value, tPTX was achieved in 80 of 109 (73.4%) patients (hemodialysis n = 27, normal kidney function: n = 43, restricted: n = 10). PTX was “subtotal” in 25 patients (22.9%), 19 on hemodialysis, 2 had normal, and 4 had restricted kidney graft function. PTX turned out to be insufficient in four patients (3.7%); all of them were on hemodialysis. Insufficient PTX was not observed in kidney-grafted patients. Postoperative temporary laryngeal nerve morbidity was 1.8% (no permanent paresis). Conclusions Although applying a very radical concept in patients with RHPT, PTX was “total” in only 73.4%. Persistence of disease was avoided in 91.7%, and low morbidity was documented. In conclusion, it seems difficult to remove all parathyroid tissue from the neck which has to be considered when choosing the surgical procedure.
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Affiliation(s)
- Thomas Burgstaller
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090, Vienna, Austria
| | - Andreas Selberherr
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090, Vienna, Austria
| | - Lindsay Brammen
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090, Vienna, Austria
| | - Christian Scheuba
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090, Vienna, Austria
| | - Klaus Kaczirek
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090, Vienna, Austria.
| | - Philipp Riss
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090, Vienna, Austria
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Veyrat M, Fessi H, Haymann JP, Ronco P, Lacau St Guily J, Périé S. Conservative three-quarter versus subtotal seven-eighths parathyroidectomy in secondary hyperparathyroidism. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 136:63-68. [PMID: 30327179 DOI: 10.1016/j.anorl.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE There is at present no consensus concerning surgical techniques for secondary hyperparathyroidism (SHPT) in end-stage renal disease (ESRD). Although both subtotal and total parathyroidectomy provide low rates of recurrence, they may induce hypoparathyroidism, damaging the bone and cardiovascular systems. The aim of our study was to compare 3/4 and 7/8 parathyroidectomy in this population and to discuss the potential benefit of more conservative treatment. STUDY DESIGN Prospective observational study in a university teaching hospital between 2010 and 2014. METHODS The study included 34 consecutive ESRD patients with SHPT: 19 underwent 3/4 parathyroidectomy (group A*3/4) and 15 underwent 7/8 parathyroidectomy (group B*7/8). Serum intact 1-84 PTH levels (before and 6 months after surgery) and hospital stay were compared between the two groups. RESULTS Before surgery, PTH levels were similar between the two groups. At month 6 following surgery, median PTH levels were significantly higher in group A*3/4 than in group B*7/8 (109 versus 24pg/mL, respectively; P<0.0006). Hospital stay was shorter in group A*3/4 (4.79 versus 6.80 days, respectively; P=0.008). Postoperative hypoparathyroidism requiring long-term calcium and 1alpha(OH) D3 treatment was reported in 5% of patients in group A*3/4 and 26% of patients in group B*7/8 (P=0.04). CONCLUSIONS In this preliminary study, 3/4 conservative parathyroidectomy seemed effective and safe, with less reported morbidity than 7/8 parathyroidectomy, as assessed by lower rates of irreversible hypoparathyroidism and shorter hospital stay. LEVEL OF EVIDENCE 3b, individual case-control study.
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Affiliation(s)
- M Veyrat
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - H Fessi
- Department of Nephrology-Dialysis, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - J-P Haymann
- Department of Functional Renal Explorations, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - P Ronco
- Department of Nephrology-Dialysis, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - J Lacau St Guily
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France
| | - S Périé
- Department of Otolaryngology Head and Neck Surgery, Tenon Hospital, Faculty of Medicine Sorbonne University, Assistance publique-Hôpitaux de Paris, AP-HP, 4, Rue de la Chine, 75020 Paris, France.
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Tang JA, Friedman J, Hwang MS, Salapatas AM, Bonzelaar LB, Friedman M. Parathyroidectomy for tertiary hyperparathyroidism: A systematic review. Am J Otolaryngol 2017; 38:630-635. [PMID: 28735762 DOI: 10.1016/j.amjoto.2017.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Analyze the efficacy and indications for parathyroidectomy as an intervention for tertiary hyperparathyroidism. DATA SOURCES PubMed, MEDLINE, and Cochrane Library databases. REVIEW METHODS A systematic literature search was performed using the. Original research articles in English were retrieved using the search terms ("tertiary hyperparathyroidism" OR "3HPT") AND "parathyroidectomy". Articles were analyzed in regards to their surgical indications, operative endpoints, comparison between different surgical interventions, characterization of disease recurrence rates, and evaluation of alternative medical management. RESULTS Thirty studies met the criteria for inclusion. Among the studies that report indications for parathyroidectomy, persistent hypercalcemia as well as clinical manifestations of hypercalcemia despite medical therapy predicted which patients would eventually need surgical intervention. The majority of studies comparing the extent of parathyroidectomy recommended a more focused approach to parathyroidectomy when warranted. All studies found that parathyroidectomy was an effective treatment for 3HPT. Three studies discussed alternative conservative approaches. CONCLUSION Interestingly, hyperparathyroidism alone is not an indication for surgery without other findings; rather, symptomatic hypercalcemia appears to be the main indication. Most studies recommend limited or subtotal parathyroidectomy for 3HPT. The operative endpoint of surgery is not necessarily a return of PTH to normal, but a >50% drop in PTH level even if PTH remains above normal. Additionally, "success" or "cure" is defined as normal calcium levels regardless of whether or not PTH is elevated. It appears the goal of surgery for 3HPT is not a normal PTH value, but a normal calcium level at least six months postoperatively.
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Dulfer RR, Franssen GJH, Hesselink DA, Hoorn EJ, van Eijck CHJ, van Ginhoven TM. Systematic review of surgical and medical treatment for tertiary hyperparathyroidism. Br J Surg 2017; 104:804-813. [PMID: 28518414 DOI: 10.1002/bjs.10554] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/23/2016] [Accepted: 03/01/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND A significant proportion of patients with chronic kidney disease and secondary hyperparathyroidism (HPT) remain hyperparathyroid after kidney transplantation, a state known as tertiary HPT. Without treatment, tertiary HPT can lead to diminished kidney allograft and patient survival. Parathyroidectomy was commonly performed to treat tertiary HPT until the introduction of the calcimimetic drug, cinacalcet. It is not known whether surgery or medical treatment is superior for tertiary HPT. METHODS A systematic review was performed and medical literature databases were searched for studies on the treatment of tertiary HPT that were published after the approval of cinacalcet. RESULTS A total of 1669 articles were identified, of which 47 were included in the review. Following subtotal and total parathyroidectomy, initial cure rates were 98·7 and 100 per cent respectively, but in 7·6 and 4 per cent of patients tertiary HPT recurred. After treatment with cinacalcet, 80·8 per cent of the patients achieved normocalcaemia. Owing to side-effects, 6·4 per cent of patients discontinued cinacalcet treatment. The literature regarding graft function and survival is limited; however, renal graft survival after surgical treatment appears comparable to that obtained with cinacalcet therapy. CONCLUSION Side-effects and complications of both treatment modalities were mild and occurred in a minority of patients. Surgical treatment for tertiary HPT has higher cure rates than medical therapy.
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Affiliation(s)
- R R Dulfer
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - G J H Franssen
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - D A Hesselink
- Department of Nephrology and Kidney Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E J Hoorn
- Department of Nephrology and Kidney Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - C H J van Eijck
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - T M van Ginhoven
- Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Okada M, Futamura K, Hiramitsu T, Tsujita M, Goto N, Narumi S, Watarai Y, Ichimori T, Tominaga Y. Hypercalcemia resistant to cinacalcet caused by a mediastinal hyperplastic parathyroid gland in a renal transplant patient. Eur Surg 2017. [DOI: 10.1007/s10353-017-0484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chudzinski W, Wyrzykowska M, Nazarewski S, Durlik M, Galazka Z. Does the Parathyroidectomy Endanger the Transplanted Kidney? Transplant Proc 2017; 48:1633-6. [PMID: 27496461 DOI: 10.1016/j.transproceed.2016.01.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Some investigators maintain that a parathyroidectomy (PTX) performed for tertiary hyperparathyroidism may potentially cause graft malfunction or even loss of the transplanted kidney after the operation. The goal of this study was to determine if parathyroidectomy affects transplanted kidney function. METHODS The study group consisted of 48 renal graft recipients who underwent operation due to tertiary hyperparathyroidism. Thirty-nine subtotal parathyroidectomies and 9 more selective, less than subtotal parathyroidectomies were performed. The estimated glomerular filtration rate (eGFR) was calculated retrospectively on days 2 to 3 and 4 to 5 and at 1, 3, 6, 12, 24, and 36 months after PTX; these findings were compared with preoperative values. The cumulative graft survival rate in the postoperative period was assessed. RESULTS In the follow-up period, 4 of 48 patients returned to hemodialysis (after 1, 7, 22, and 57 months after PTX). In the first case, the patient had stopped taking the immunosuppressive drugs 1 month after PTX. Cumulative graft survival rate after PTX was 98.0% after 6 months, 96% after 12 months, and 93% after 2 and 3 years. The mean preoperative eGFR was 52 ± 17.15 mL/min/1.73 m(2), and the median was 48.28 mL/min/1.73 m(2). Overall and in the subtotal parathyroidectomy group, eGFR was significantly lower (P < .001) only on days 2 to 3. There were no differences between preoperative and postoperative eGFR values in the other follow-up periods. In the more selective, less than subtotal parathyroidectomy group, the decrease in eGFR values was nonsignificant compared with preoperative findings in the early postoperative period as well as in all follow-up periods. CONCLUSIONS In this study, PTX did not significantly impair transplanted kidney function, but in the early postoperative period, transient reductions in graft function did occur.
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Affiliation(s)
- W Chudzinski
- Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - M Wyrzykowska
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - S Nazarewski
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Z Galazka
- Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland
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Abstract
BACKGROUND Persistent hyperparathyroidism (HPT) after renal transplantation (RTx), termed tertiary HPT (THPT), is not uncommon. However, risk factors and appropriate operative procedures for THPT are poorly understood. METHODS A retrospective study of patients who underwent RTx without pre-transplant parathyroidectomy (PTx) was performed at our hospital between January 2001 and March 2011. Risk factors for the development of THPT were investigated by comparing THPT and non-THPT groups. We retrospectively analyzed patients with THPT who underwent total PTx with forearm autograft. Pre- and postoperative (1 year after PTx) laboratory results were analyzed for PTx efficacy. RESULTS Data for 520 patients were analyzed. On multivariate analysis, long dialysis duration (p = 0.009, hazard ratio (HR) 1.01), large maximum parathyroid gland size before RTx (p = 0.003, HR 1.23), pre-RTx high intact parathyroid hormone (iPTH) (p = 0.041, HR 1.01), post-RTx (<2 weeks) high calcium (Ca) (p < 0.001, HR 25.04), and post-RTx high alkaline phosphatase (ALP) (p = 0.027, HR 0.99) were identified as risk factors for THPT. Patients who underwent PTx showed significant improvement compared with baseline for serum Ca, phosphorus, iPTH, and ALP. Serum creatinine showed no significant difference. CONCLUSIONS Several risk factors for THPT development were identified. PTx for patients with THPT significantly improved serum Ca, iPTH, ALP, and phosphorous levels. There was no significant difference in renal function after PTx. Therefore, total PTx with forearm autograft may be an appropriate surgical approach for patients with THPT.
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20
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The Changing Landscape of Primary, Secondary, and Tertiary Hyperparathyroidism: Highlights from the American College of Surgeons Panel, “What's New for the Surgeon Caring for Patients with Hyperparathyroidism”. J Am Coll Surg 2016; 222:1240-50. [DOI: 10.1016/j.jamcollsurg.2016.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/27/2022]
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21
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Xu D, Yin Y, Hou L, Dai W. Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery. J Endocrinol Invest 2016; 39:509-14. [PMID: 26620950 DOI: 10.1007/s40618-015-0410-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/05/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Successful parathyroidectomy (PTX) often results in a dramatic drop in the parathyroid hormone (PTH) levels, relieves the patient from clinical symptoms, and reduces mortality. Although PTX is generally a successful treatment for progressive secondary hyperparathyroidism (SHPT) patients subjected to surgery, a significant proportion develops recurrent SHPT following PTX. KEY MESSAGE SHPT requiring PTX occurs more commonly in progressive chronic kidney disease and in long-term lithium therapy. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages, and disadvantages. Although PTX offers the highest percentage cure for SHPT, compared to all other medical and surgical treatment, recurrent hyperparathyroidism can be observed in some patients dependent on follow-up time. A literature review and analysis of recent data regarding how to reduce recurrence of SHPT at the time of primary surgery was performed. The current literature and our own experience in the field have confirmed that pre-operative imaging, thymectomy, stereo magnifier, and surgical procedure may effectively reduce recurrence of SHPT at the time of primary surgery.
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Affiliation(s)
- D Xu
- Department of Emergency Surgery, The First Affiliated Hospital Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Y Yin
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - L Hou
- Department of Emergency Surgery, The First Affiliated Hospital Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People's Republic of China.
| | - W Dai
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People's Republic of China.
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Su Y, Zhang Z, Zhang Q, Zhang Y, Liu Z. Analgesic efficacy of bilateral superficial and deep cervical plexus block in patients with secondary hyperparathyroidism due to chronic renal failure. Ann Surg Treat Res 2015; 89:325-9. [PMID: 26665128 PMCID: PMC4672097 DOI: 10.4174/astr.2015.89.6.325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 08/18/2015] [Indexed: 12/03/2022] Open
Abstract
Purpose Secondary hyperparathyroidism (SHPT) develops in patients with chronic renal failure. This study aimed to compare analgesic efficacy in SHPT patients who undergo subtotal parathyroidectomy after superficial versus deep cervical plexus block. Methods Sixty chronic renal failure patients with SPHT scheduled for subtotal parathyroidectomy were randomized to receive general anesthesia (group GA), general anesthesia plus bilateral superficial and deep cervical plexus block (group BD), or general anesthesia plus bilateral superficial cervical plexus block (group BS) (n = 20). Bilateral superficial cervical plexus block or combined superficial and deep cervical plexus block with 0.5% ropivacaine was administered. Postoperative pain was assessed using visual analogue scale (VAS). Results VAS score at 1 hour, 4 hours, and 8 hours after operation was 3.71 ± 0.60, 2.72 ± 0.54, 2.17 ± 0.75 in BS group; 4.00 ± 0.28, 2.89 ± 0.21, and 2.46 ± 1.01 in BD group, significantly lower than in GA group (6.50 ± 0.50, 5.02 ± 0.54, and 4.86 ± 0.51, respectively). The dosage of tramadol was 109.0 ± 35.2 mg in BS group and 93.0 ± 24.52 mg in BD group, significantly lower than in GA group (300.0 ± 27.13 mg). The incidence of complications in GA group (90%) was significantly higher than in BS group (30%) and BD group (15%). Serum glucose and norepinephrine levels were significantly higher at 1 hour, 4 hours, and 8 hours after operation, but returned to baseline levels at 24 hours after operation. Conclusion Superficial cervical plexus block or combined superficial and deep cervical plexus block effectively reduces postoperative pain, stress response, and complications in SHPT patients who undergo subtotal parathyroidectomy.
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Affiliation(s)
- Yinglan Su
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
| | - Zhongjun Zhang
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
| | - Qiuli Zhang
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
| | - Yaoxian Zhang
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
| | - Zhanli Liu
- Department of Anesthesiology, The Second Clinical Medical College of JiNan University, Shenzhen People's Hospital, Shenzhen, China
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Lorenz K, Bartsch DK, Sancho JJ, Guigard S, Triponez F. Surgical management of secondary hyperparathyroidism in chronic kidney disease--a consensus report of the European Society of Endocrine Surgeons. Langenbecks Arch Surg 2015; 400:907-27. [PMID: 26429790 DOI: 10.1007/s00423-015-1344-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 09/18/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. METHODS Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective. RESULTS Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. CONCLUSIONS Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and long-term control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.
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Affiliation(s)
- Kerstin Lorenz
- Department of General-, Visceral-, and Vascular Surgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube-Str. 40, Halle (Saale), 06120, Germany.
| | - Detlef K Bartsch
- Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstraße 1, Marburg, 35043, Germany.
| | - Juan J Sancho
- Department of General Surgery, Endocrine Surgery Unit, Hospital del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, Barcelona, 08003, Spain.
| | - Sebastien Guigard
- Department of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Switzerland, Rue Gabrielle Perret-Gentil 4, 14, Geneva, 1211, Switzerland.
| | - Frederic Triponez
- Chirurgie thoracique et endocrinienne, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, 14, Geneva, 1211, Switzerland.
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Jäger MD, Emmanouilidis N, Jackobs S, Kespohl H, Hett J, Musatkin D, Tränkenschuh W, Schrem H, Klempnauer J, Scheumann GFW. Presence of small parathyroid glands in renal transplant patients supports less-than-total parathyroidectomy to treat hypercalcemic hyperparathyroidism. Surgery 2013; 155:22-32. [PMID: 24621404 DOI: 10.1016/j.surg.2013.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 06/20/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Parathyroid glands (PG) are rarely analyzed in renal transplant (RTX) patients. This study analyzes comparatively PG of RTX and end-stage renal disease (ESRD) patients. The clinical part of the study evaluates if total parathyroidectomy with autotransplantation (TPT+AT) treats appropriately hypercalcemic hyperparathyroidism in RTX patients. METHODS TPT+AT was performed in 15 of 23 RTX and 21 of 27 ESRD patients. Remaining patients underwent less-than-total PT. Volume and stage of hyperplasia were determined from 86 PG of RTX and 109 PG of ESRD patients. Patients were categorized according to the presence of small PG (volume < 100 mm(3)). Calcium homeostasis and hyperparathyroidism were evaluated 2 years after PT in RTX patients. RESULTS PG of RTX patients were significantly smaller, but similar hyperplastic in comparison to PG of ESRD patients. Small PG were more frequent in RTX than in ESRD patients (19% vs 6%) and mainly graded normal or diffuse hyperplastic (94%). Forty-seven percent of RTX, but only 14% of ESRD, patients receiving a total PT possessed ≥1 small PG (P < .05). Overall, PT treated successfully hypercalcemic hyperparathyroidism. However, TPT+AT caused permanent hypocalcemia in 50% of RTX patients without small PG and even in 83% of RTX patients with small PG. All RTX patients receiving less-than-total PT were normocalcemic at 2-year follow-up. Logistic regression revealed a 10.7 times greater risk of permanent hypocalcemia in RTX patients with small PG receiving TPT+AT compared with RTX patients without small PG receiving TPT+AT or RTX patients undergoing less-than-total PT. CONCLUSION Surgeons performing PT should be aware of the high frequency of small and less diseased PG in RTX patients. In this context, TPT+AT might overtreat hypercalcemic hyperparathyroidism in RTX patients, especially when small PG are present.
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Affiliation(s)
- Mark D Jäger
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
| | - Nikos Emmanouilidis
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Steffan Jackobs
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Holger Kespohl
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Julian Hett
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Denis Musatkin
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Harald Schrem
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jürgen Klempnauer
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Georg F W Scheumann
- Klinik für Allgemein-, Viszeral- and Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
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Fukagawa M, Yokoyama K, Koiwa F, Taniguchi M, Shoji T, Kazama JJ, Komaba H, Ando R, Kakuta T, Fujii H, Nakayama M, Shibagaki Y, Fukumoto S, Fujii N, Hattori M, Ashida A, Iseki K, Shigematsu T, Tsukamoto Y, Tsubakihara Y, Tomo T, Hirakata H, Akizawa T. Clinical Practice Guideline for the Management of Chronic Kidney Disease-Mineral and Bone Disorder. Ther Apher Dial 2013; 17:247-88. [DOI: 10.1111/1744-9987.12058] [Citation(s) in RCA: 251] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We reviewed the etiology and management of secondary and tertiary hyperparathyroidism. Secondary hyperparathyroidism is characterized by an increase in parathyroid hormone (PTH) that is appropriate and in response to a stimulus, most commonly low serum calcium. In secondary hyperparathyroidism, the serum calcium is normal and the PTH level is elevated. Tertiary hyperparathyroidism is characterized by excessive secretion of PTH after longstanding secondary hyperparathyroidism, in which hypercalcemia has ensued. Tertiary hyperparathyroidism typically occurs in men and women with chronic kidney disease usually after kidney transplant. The etiology and treatment of secondary hyperparathyroidism is relatively straightforward whereas data on the management of tertiary hyperparathyroidism is limited to a few small trials with short follow-up.
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Affiliation(s)
- Sophie A Jamal
- University of Toronto, Women's College Research Institute, Toronto, Ontario, Canada.
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Jeon HJ, Kim YJ, Kwon HY, Koo TY, Baek SH, Kim HJ, Huh WS, Huh KH, Kim MS, Kim YS, Park SK, Ahn C, Yang J. Impact of parathyroidectomy on allograft outcomes in kidney transplantation. Transpl Int 2012; 25:1248-56. [PMID: 23020185 DOI: 10.1111/j.1432-2277.2012.01564.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We performed retrospective, multi-center study of the impacts of parathyroidectomy (PTX) after or before kidney transplantation on allograft outcomes. A total of 63 patients who underwent PTX after kidney transplantation were identified. Deterioration in eGFR by more than 25% at 1 month after PTX occurred in 20% of the patients. The baseline eGFR was significantly lower in impairment group than nonimpairment group [adjusted odds ratio (OR) 0.87, 95% confidence interval (CI) 0.77-0.99, P = 0.033]. Low iPTH concentration after PTX was also a significant risk factor for the renal impairment (OR 0.96, CI 0.94-0.99, P = 0.009). A total of 37 patients who underwent PTX before transplantation were identified. Thirty-six percent of the patients had persistent hyperparathyroidism by 1 year after transplantation. A high iPTH level before PTX was a significant risk factor for persistent post-transplant hyperparathyroidism (adjusted OR 1.002, CI 1.000-1.005, P = 0.039). Finally, eGFR values during the first 5 years after transplantation were significantly lower in the patients who underwent PTX at less than 1 year after transplantation, than the pretransplant PTX patients (P = 0.032). As PTX after kidney transplantation has a risk of deterioration of allograft function, pretransplant PTX should be considered for patients with severe hyperparathyroidism, who could undergo post-transplant PTX.
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Affiliation(s)
- Hee Jung Jeon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
BACKGROUND The aim of the present study was to evaluate the outcome of different surgical procedures for patients on permanent dialysis who underwent initial parathyroidectomy for renal hyperparathyroidism (rHPT). METHODS Out of a prospective database of patients who underwent parathyroid surgery for rHPT between 1976 and 2009, patients on permanent dialysis who underwent initial parathyroidectomy were further analyzed regarding perioperative biochemical changes and postoperative outcome. RESULTS A total of 606 patients were analyzed. Total parathyroidectomy with autotransplantation (group A) was performed in 504 patients, total parathyroidectomy without autotransplantation in 32 (group B), subtotal parathyroidectomy in 21 (group C), and incomplete parathyroidectomy in 49 (group D). After surgery, mean calcium levels dropped from 2.76 to 1.91 mmol/l in group A, from 2.67 to 2.11 mmol/l in group B, from 2.70 to 2.09 mmol/l in group C, and from 2.65 to 1.94 mmol/l in group D. The parathyroid hormone level dropped from 1,371.4 pg/ml to 28.8 pg/ml in group A, from 1,078.4 pg/ml to 27.0 pg/ml in group B, from 2,377.9 pg/ml to 61.4 pg/ml in group C, and from 1,010.2 pg/ml to 99.5 pg/ml in group D. Persistent rHPT occurred in 2/504 patients from group A (0.4%), 0/32 patients from group B (0%), 1/21 patients from group C (4.8%), and 2/49 patients from group D (4.1%). After a mean follow-up of 57.6 months, recurrent rHPT occurred in 27/504 patients from group A (5.4%), in 0/32 patients from group B (0%), in 2/21 patients from group C (9.5%), and in 3/49 patients from group D (6.1%). CONCLUSIONS Total parathyroidectomy with or without autotransplantation is a feasible and safe surgical procedure for patients on permanent dialysis with otherwise uncontrollable rHPT.
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Hsieh TM, Sun CK, Chen YT, Chou FF. Total Parathyroidectomy versus Subtotal Parathyroidectomy in the Treatment of Tertiary Hyperparathyroidism. Am Surg 2012. [DOI: 10.1177/000313481207800544] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purposes of this study are to evaluate the merits of surgical treatment, including subtotal parathyroidectomy (SP) and total parathyroidectomy (TP), in patients with tertiary hyperparathyroidism (THPT) and compare the outcome of the two surgical options. Medical records of patients undergoing parathyroidectomy for THPT were retrospectively reviewed and long-term outcomes between the two groups were compared. Fourteen out of 488 renal transplantation recipients required parathyroidectomy for THPT during a 24-year follow-up period with a median follow-up of 35.5 [interquartile range (IQR), 19.3–133.3] months. All patients had hypercalcemia, whereas 13 had varying symptoms and one was asymptomatic. Median serum calcium level decreased from 12.4 (IQR, 11.9–12.6) mg/dL preoperatively to 8.9 (IQR, 8.1–9.4) mg/dL postoperatively ( P = 0.001), whereas median intact parathyroid hormone (iPTH) dropped from a preoperative level of 340.5 (IQR, 247–540) pg/mL to 55.1 (IQR, 24.4–66.4) pg/mL after surgery ( P = 0.018). Comparison between patients receiving TP and SP revealed no difference in incidence of recurrence or permanent complications, whereas the former had significantly lower calcium levels ( P = 0.048) and higher phosphorus levels ( P = 0.017) compared with the latter. Moreover, a significant reduction in calcium level was noted in TP group on long-term follow-up compared with their immediately postoperative level (8.1 vs 9.0 mg/dL, respectively, P < 0.05), whereas there was no significant decrease in SP group. We concluded that parathyroidectomy is efficient and safe in treating THPT. Because TP would increase the risk of hypocalcemia, a less radical procedure (SP) is preferred.
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Affiliation(s)
- Ting-Min Hsieh
- Divisions of General Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Ta Chen
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Fong-Fu Chou
- Divisions of General Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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[Increased bone mineral density in patients with tertiary hyperparathyroidism after total parathyroidectomy and autotransplantation of the parathyroid gland]. Cir Esp 2012; 90:382-7. [PMID: 22445112 DOI: 10.1016/j.ciresp.2012.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 01/08/2012] [Accepted: 01/12/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Changes in bone metabolism and bone mineral density are observed in renal transplant patients with tertiary hyperparathyroidism. The objective of this work was to analyse the increase in bone mineral density, as well the laboratory results, after total parathyroidectomy and autotransplantation in renal transplant patients with tertiary hyperparathyroidism. MATERIAL AND METHODS A retrospective study was conducted in which the bone mineral density values at femoral and lumbar level were analysed, together with the serum levels of calcium, phosphorous, parathyroid hormone (PTH), and alkaline phosphatase in 13 renal transplant patients with tertiary hyperparathyroidism before and after total parathyroidectomy and autotransplantation of the parathyroid glands. RESULTS Parathyroidectomy is associated with an increase in bone mineral density at femoral and lumbar level, with an increase of 8.6 ± 6.7% at lumbar level, and 4 ± 16.1% at femoral level. The decrease in calcium after the parathyroidectomy was 2.8 mg/dL (95% CI; 1.9-4). The decrease in PTH was 172 pg/mL (95% CI; 98-354) and the decrease in alkaline phosphatase was 229 U/L (95% CI; 70-371). CONCLUSIONS Total parathyroidectomy and autotransplantation of the parathyroid glands in renal transplant patients with tertiary hyperparathyroidism increases the bone mineral density. Furthermore, the calcium, PTH and alkaline phosphatase returned to normal in the long-term.
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The calcitonin levels can sometimes mislead parathyroid surgeons in patients with chronic kidney disease and renal hyperparathyroidism: report of a case. Surg Today 2012; 43:429-33. [DOI: 10.1007/s00595-012-0131-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
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Montenegro FM, Brandão LG, Ferreira GF, Lourenço DM, Martin RM, Cunha-Neto MB, Helou CB, Toledo SA, Cordeiro AC, Ianhez LE. Transitory increase in creatinine levels after parathyroidectomy: evidence of another action of the parathyroid glands? ACTA ACUST UNITED AC 2012; 55:249-55. [PMID: 21779626 DOI: 10.1590/s0004-27302011000400002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 01/28/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Little information is available on glomerular function changes after surgical treatment of primary hyperparathyroidism. The acute effects of some head and neck operations on renal function were studied. MATERIAL AND METHODS Retrospective analysis of changes in creatinine levels and estimated glomerular filtration rate (eGFR) after surgery. Preoperative values were compared with values available until 72 hours after the operation. RESULTS In tertiary hyperparathyroidism, mean preoperative and postoperative eGFR values were 57.7 mL/min and 40.8 mL/min (p < 0.0001), respectively. A similar decrease was observed after parathyroidectomy for primary hyperparathyroidism, from 85.4 mL/min to 64.3 mL/min (p < 0.0001). After major head and neck procedures, there was a slight increase in eGFR (from 94.3 mL/min to 105.4 mL/min, p = 0.002). CONCLUSION Parathyroidectomy may be followed by a transient decrease in eGFR that is not often observed in other head and neck operations.
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Affiliation(s)
- Fábio M Montenegro
- Head and Neck Surgery, Department of Surgery, Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil.
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The Japanese Society for Dialysis Therapy. Clinical Practice Guideline for CKD-MBD. ACTA ACUST UNITED AC 2012. [DOI: 10.4009/jsdt.45.301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Madorin C, Owen RP, Fraser WD, Pellitteri PK, Radbill B, Rinaldo A, Seethala RR, Shaha AR, Silver CE, Suh MY, Weinstein B, Ferlito A. The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol 2011; 269:1565-76. [PMID: 22101574 DOI: 10.1007/s00405-011-1833-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/30/2011] [Indexed: 01/22/2023]
Abstract
Secondary and tertiary hyperparathyroidism (HPT) develop in patients with renal failure due to a variety of mechanisms including increased phosphorus and fibroblast growth factor 23 (FGF23), and decreased calcium and 1,25-dihydroxy vitamin D levels. Patients present with various bone disorders, cardiovascular disease, and typical laboratory abnormalities. Medical treatment consists of controlling hyperphosphatemia, vitamin D/analog and calcium administration, and calcimimetic agents. Improved medical therapies have led to a decrease in the use of parathyroidectomy (PTX). The surgical indications include parathyroid hormone (PTH) levels >800 pg/ml associated with hypercalcemia and/or hyperphosphatemia despite medical therapy. Other indications include calciphylaxis, fractures, bone pain or pruritis. Transplant recipients often show decreased PTH, calcium and phosphorus levels, but some will have persistent HPT. Evidence suggests that PTX may cause deterioration in renal graft function in the short-term calling into the question the indications for PTX in these patients. Pre-operative imaging is only occasionally helpful except in re-operative PTX. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages and disadvantages which are discussed. Intraoperative PTH monitoring has a high positive predictive value of cure but a poor negative predictive value and therefore is of limited utility. Hypocalcemia is the most common complication requiring aggressive calcium administration. Benefits of surgery may include improved survival, bone mineral density and alleviation of symptoms.
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Affiliation(s)
- Catherine Madorin
- Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Mount Sinai School of Medicine, New York, NY, USA
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Total parathyroidectomy without autotransplantation after renal transplantation for tertiary hyperparathyroidism: long-term follow-up. Int Urol Nephrol 2011; 44:275-81. [DOI: 10.1007/s11255-011-0069-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 09/26/2011] [Indexed: 10/16/2022]
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Park JH, Kang SW, Jeong JJ, Nam KH, Chang HS, Chung WY, Park CS. Surgical treatment of tertiary hyperparathyroidism after renal transplantation: a 31-year experience in a single institution. Endocr J 2011; 58:827-33. [PMID: 21804261 DOI: 10.1507/endocrj.ej11-0053] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tertiary hyperparathyroidism (tHPT) most commonly refers to a persistent secondary hyperparathyroidism even after successful renal transplantation. Parathyroidectomy (PTX) is an efficient method for treatment of tHPT. In this study, we examined our 31-year experience with patients who underwent PTX for tHPT after KTX and assessed the effects of PTX on graft function according to the type of surgery. Among 2,981 recipients who underwent renal allograft between April 1979 and Dec. 2010, 15 patients (0.5%) were identified as having tHPT and underwent PTX. Levels of intact parathyroid hormone (iPTH) and serum calcium were measured before and after PTX for evaluation of the therapeutic effect, and glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation for investigation of any effect on graft function. One patient showed persistent hyperparathyroidism and hypercalcemia after limited PTX. We experienced 14 successful PTXs, including 3 total PTX with autotransplantations, 8 subtotal PTXs, and 3 limited PTXs. Level of iPTH and serum calcium were at normal range after PTX. Estimated GFR decreased after PTX. Total PTX with autotransplantation showed a tendency of more decrease in the values of iPTH, and GFR after PTX than Subtotal PTX. PTX can cure tHPT-specific symptoms and signs by recovery of hypercalcemia, but may carry the risk of deterioration of kidney graft function. We suspect that subtotal PTX, rather than total PTX with AT, prevent any risk of kidney graft deterioration in surgical treatment of tHPT, and, in selective tHPT patients, limited PTX might be recommended.
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Affiliation(s)
- Jae Hyun Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
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Ferreira GF, Montenegro FLDM, Machado DJ, Ianhez LE, Nahas WC, David-Neto E. Parathyroidectomy after kidney transplantation: short-and long-term impact on renal function. Clinics (Sao Paulo) 2011; 66:431-5. [PMID: 21552668 PMCID: PMC3072004 DOI: 10.1590/s1807-59322011000300012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/30/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Kidney transplantation corrects endocrine imbalances. Nevertheless, these early favorable events are not always followed by rapid normalization of parathyroid hormone secretion. A possible deleterious effect of parathyroidectomy on kidney transplant function has been reported. This study aimed to compare acute and longterm renal changes after total parathyroidectomy with those occurring after general surgery. MATERIALS AND METHODS This was a retrospective case-controlled study. Nineteen patients with persistent hyperparathyroidism underwent parathyroidectomy due to hypercalcemia. The control group included 19 patients undergoing various general and urological operations. RESULTS In the parathyroidectomy group, a significant increase in serum creatinine from 1.58 to 2.29 mg/dl (P < 0.05) was noted within the first 5 days after parathyroidectomy. In the control group, a statistically insignificant increase in serum creatinine from 1.49 to 1.65 mg/dl occurred over the same time period. The long-term mean serum creatinine level was not statistically different from baseline either in the parathyroidectomy group (final follow-up creatinine = 1.91 mg/dL) or in the non-parathyroidectomy group (final follow-up creatinine = 1.72 mg/dL). CONCLUSION Although renal function deteriorates in the acute period following parathyroidectomy, long-term stabilization occurs, with renal function similar to both preoperative function and to a control group of kidney-transplanted patients who underwent other general surgical operations by the final follow up.
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[Indications for parathyroidectomy in renal hyperparathyroidism: comments on the significance of new therapeutics]. Chirurg 2010; 81:902-8. [PMID: 20683565 DOI: 10.1007/s00104-010-1968-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
New therapeutics for the treatment of chronic kidney disease and secondary hyperparathyroidism, such as calcium and aluminium-free phosphate binders, calcimimetic agents and active vitamin D metabolites may decrease the need for parathyroidectomy. The calcimimetic cinacalcet does not induce a longer lasting regression of renal hyperparathyroidism and autonomous growing of parathyroids and the therapeutic effect is limited to the period of treatment. The classical indications for surgery, hypercalcemia, vascular calcification, severe osteopathy, drug-resistant hyperphosphatemia and calciphylaxis are still valid if patients do not respond to medical therapy under the condition that adynamic bone disease is excluded. Individual operative risk factors and improvement of quality of life are important supplementary factors for the indication for parathyroidectomy.
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CT-MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism. Langenbecks Arch Surg 2009; 395:73-80. [DOI: 10.1007/s00423-009-0545-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 07/14/2009] [Indexed: 12/18/2022]
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Ramakant P, Agarwal G. Surgical treatment of tertiary hyperparathyroidism: the choice of procedure matters: surgical management of tertiary hyperparathyroidism: an enigma. World J Surg 2009; 32:1894; author reply 1895-6. [PMID: 18404286 DOI: 10.1007/s00268-008-9572-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Montenegro F, Ferreira G, Ianhez L. Surgical treatment of tertiary hyperparathyroidism: the choice of procedure matters! World J Surg 2009; 32:1892-3; author reply 1895-6. [PMID: 18204944 DOI: 10.1007/s00268-007-9413-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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42
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de Menezes Montenegro FL, Martin RM, Corrêa PHS. Renal failure after surgery for primary hyperparathyroidism: is acute reduction of parathyroid function a risk factor? Clinics (Sao Paulo) 2009; 64:369-72. [PMID: 19488597 PMCID: PMC2694470 DOI: 10.1590/s1807-59322009000400017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Cinacalcet Increases Calcium Excretion in Hypercalcemic Hyperparathyroidism After Kidney Transplantation. Transplantation 2008; 86:919-24. [DOI: 10.1097/tp.0b013e318186b7fb] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Minimally invasive video-assisted subtotal parathyroidectomy with thymectomy for secondary hyperparathyroidism. Langenbecks Arch Surg 2008; 394:451-5. [DOI: 10.1007/s00423-008-0413-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 08/11/2008] [Indexed: 01/27/2023]
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Reply. World J Surg 2008. [DOI: 10.1007/s00268-008-9612-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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