Secondary hyperparathyroidism: pathophysiology and therapy--follow-up analysis of patients of the Chur dialysis department

Abstract

Between 1982 and 1998 12 chronic dialysis patients treated at the dialysis unit of Kantonsspital Chur were operated for secondary hyperparathyroidism (HPT). In 10 patients total parathyroidectomy with autotransplantation of parathyroid tissue was performed. Two patients had subtotal parathyroidectomy. Patient data were retrospectively analyzed in regard to indication, operation techniques, pharmacological therapy and possible recurrence or persistence of HPT. Four patients had normal PTH levels upon follow up. The parathyroid function was judged "equivocal" in three patients, the average PTH being to high (1), normal (1) and too low (1). One patient showed moderate hyperparathyroidism. Two patients developed recurrence of HPT one of which was sufficiently severe to necessitate reoperation at the autotransplantation site. In the first two operated patients the data are missing. Compared with other studies the rate of recurrence is higher in our series. Intraoperative ultrasound and improving diagnosis of the frozen sections could possibly favorably influence outcome.