Abstract
Surgical treatment of secondary (SHPT) and tertiary hyperparathyroidism (THPT) may involve various surgical approaches. The aim of this paper was to evaluate presternal intramuscular autotransplantation of parathyroid tissue as a surgical option in SHPT and THPT treatment. 66 patients with renal chronic disease underwent surgery from April 2000 to April 2005 at Universidade Federal São Paulo, Brazil. There were 38 SHPT patients (24 women/14 men), mean age of 39.yrs (range: 14–58), and 28 THPT patients (14 women/14 men), mean age of 43.4 yrs (range: 24–62). Postoperative average followup was 42.9 months (range: 12–96). Postoperative intact PTH increased throughout followup from 73.5 pg/mL to 133 pg/mL on average from 1st to the 5th year, respectively, in SHPT and from 54.9 pg/mL to 94.7 pg/mL on average from 1st to 5th year, respectively, in THPT group. Definitive hypoparathyroidism was observed in 4 (6.06%) patients and graft-dependent recurrence in 6 (9.09%). Presternal intramuscular autotransplantation of parathyroid tissue is a feasible and safe surgical option in SHPT and THPT treatment.
Highlights
Secondary hyperparathyroidism is a frequent and potentially severe complication in patients with renal chronic disease, evolving metabolic bone disease, severe atherosclerosis, and undesirable cardiovascular events
Patients from secondary hyperparathyroidism (SHPT) group presented with an average of 7.8 years under dialysis treatment before parathyroidectomy, and tertiary hyperparathyroidism (THPT) group comprised patients who had undergone dialysis treatment for an average of 6.12 years before receiving a kidney graft, with an average of 2.6 years of functional renal graft before parathyroidectomy (Table 1)
One patient was not cured after four-gland excision, whose intraoperative parathyroid hormone (PTH) decrease was only 62.1%
Summary
Secondary hyperparathyroidism is a frequent and potentially severe complication in patients with renal chronic disease, evolving metabolic bone disease, severe atherosclerosis, and undesirable cardiovascular events. Despite recent advances in medical therapy, surgical approach is necessary in a considerable number of uremic patients [1]. The best surgical approach for renal hyperparathyroidism is yet to be defined. Controversy remains raising relevant questions regarding treatment election, once neither high postsurgical recurrence rates nor risks of definitive hypoparathyroidism are intended. The aim of this paper was to evaluate hyperparathyroidism recurrence rates and prevalence of definitive hypoparathyroidism in a long-term followup after total parathyroidectomy with presternal intramuscular autotransplantation in patients with secondary and tertiary hyperparathyroidism
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