Surgical treatment of secondary hyperparathyroidism. A clinical study of 70 patients

Abstract

AIM: The Authors analyze the short and long-term results of surgical treatment in 70 consecutive patients operated on from for secondary Hyperparathyroidism (2HPT) of chronic kidney disease (CKD).

MATERIAL OF STUDY: Seventy patients affected by 2HPT of CKD, in hemodialytic treatment, were observed from January 1999 to January 2009. Twentyseven patients were submitted to total parathyroidectomy (TP), 36 pts were submitted to total parathyroidectomy plus subcutaneous autoimplantation (TP ai), 7 pts were submitted to subtotal parathyroidectomy (SP).

RESULTS: An improvement of the typical clinical symptoms was found in every patient undergoing surgery, and a significant reduction in intact parathyroid hormone (iPTH) serum levels was achieved. TP determined a lower incidence of one year relapse. After TPai 9/36 pts successfully underwent renal transplantation.

DISCUSSION: To date surgical treatment of 2HPT is still controversial. SP and TPai are the most commonly adopted surgical interventions while TP had been previously been confined to patients with advanced dialytic vintage or for the treatment of recurrence, for the risks arising from aparathyroidism. TP allows a lower long-term relapse incidence and managing the resulting hypoparathyroidism appears straightforward with medical treatment.

CONCLUSIONS: The Authors are in favour of early surgical intervention to prevent cardiovascular complications. TPai may be the operation of choice in patients eligible for kidney transplantation while TP, carachterized by a lower incidence of long term relapse, is reserved to patients not eligible for transplantation and affected by a more “aggressive” forms of 2HPT.