Recidiva-persistencia en la cirugía del hiperparatiroidismo renal

Abstract

Introduction We evaluated recurrence and persistence after surgery for renal hyperparathyroidism. Material and method We studied 67 patients from a hemodialysis population of 787 patients (8.5 %) treated between January 1984 and December 2004. Total parathyroidectomy and either muscular antebrachial or subcutaneous presternal transplantation was performed. Indications for surgery included intact parathyroid hormone > 500 pg/mL, with or without severe clinical symptoms. Results Of the 39 patients treated with total parathyroidectomy and muscular antebrachial transplantation, persistence-recurrence developed in 5 patients (12.8 %). There were 2 cases of persistence, one due to incomplete surgery and the other due to a mediastinal supernumerary gland, and 3 recurrences on transplanted tissue. No recurrences were observed in patients who underwent presternal subcutaneous transplantation. Conclusions Persistence and recurrence must be considered in surgery for renal hyperparathyroidism. 99Tc-sestamibi scanning allows the cause of these complications to be detected.