Abstract
Introduction: Reducing serum parathyroid hormone (PTH) level in patients with chronic renal failure can be achieved either by medical treatment or by parathyroidectomy. However, the long-term outcome of parathyroidectomy is better. More than one surgical technique can be done and there is no consensus about the best technique. Objectives: In this study, we present our results in different techniques for parathyroidectomy for these children. Patients and Methods: Six patients of both sexes with chronic renal failure and secondary hyperparathyroidism were collected from pediatric surgery department, Ain Shams University in the period between October 2014 and October 2015. All these patients underwent parathyroidectomy (Subtotal with preservation of half a gland in three patients, Subtotal with preservation of a whole gland in two patients and total with auto-transplantation in one patient). Patients were followed up for serum PTH and calcium levels to detect recurrence of hyperparathyroidism. Results: Serum PTH and calcium levels dropped to normal levels after three months, in 3 of 6 patients (one with preservation of half of a gland, one with preservation of a whole gland and one with total parathyroidectomy and auto-transplantation). Two patients developed hypercalcemia and increased PTH level (one with preservation of half of a gland and the other with preservation of a whole gland). The sixth patient died one month postoperatively (the one with preservation of half of a gland). Conclusion: There is no consensus upon the preferred surgical technique of parathyroidectomy in children with chronic renal failure and secondary hyperparathyroidism.
Highlights
Renal osteodystrophy is an important complication of secondary hyperparathyroidism
Patients and Methods This study was carried out on six patients of both sexes (5 males and 1 female) who presented with chronic renal failure and secondary hyperparathyroidism and underwent parathyroidectomy, in pediatric surgery department, Ain Shams University in the period between October 2014 and October 2015
Follow up of the postoperative serum levels of parathyroid hormone and calcium is important to document the success of the operation done
Summary
Renal osteodystrophy is an important complication of secondary hyperparathyroidism. It results from disturbance in calcium-phosphate homeostasis and alteration in vitamin D and parathyroid hormone (PTH) metabolism [1]. It leads to skeletal deformities and growth retardation. A broad spectrum of bone remodeling disorders can result, ranging from high-turnover lesions (osteitis fibrosa cystica) to low-turnover lesions (adynamic bone disease and osteomalacia) [2]. Lowering serum level of PTH is crucial to prevent this complication. Medical treatment achieved some success in doing that, the long-term outcome of parathyroidectomy is better [3]
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