Endocrine Abstracts

Background: Renal hyperparathyroidism (RHPT) is a frequent complication of uremic patients on hemodialysis and despite various advances in medical therapy parathyroidectomy is necessary in a semnificative number of cases.

Patients and methods: We reviewed our experience (first in Romania) regarding thirtyfour patients with RHPT operated on in our clinic between 1994 and 2007 evaluating the diagnosis methods, surgical indications, techniques and results together with the evolution of our own therapeutical concept. The study included 20 men and 14 women of median age of 48 (range 26–75) years, performing hemodialysis (n=32) or peritoneal dialysis (n=2) from 8.2 (range 3 to 16) years respectively. Two patients received an unsuccessful renal graft. The diagnosis was established by anamnesis, clinical complaints (mainly osteoarticular pains,osteoporosis, fractures and divulsions), muscle weakness, severe itching and mental troubles), completed by anormal values of calcaemia, hyperphosphataemia and intact PTH. Ultrasonography and CT scan were useful only in ‘adenomised’ parathyroids and co-existent thyroid pathology.

Results: All the patients were operated on. Twenty subtotal parathyroidectomies 12 total parathyroidectomies (4 with autoimplantation), and two limited resections (adenomectomies) were performed (two video-assisted). There were no deaths and the operative morbidity was 2,9% (vocal cord hemiparesis – one case). Pathology revealed that RHTP was due to four gland diffuse hyperplasia (n=18) or nodular hyperplasia (n=14).Two neglected parathyroid adenomas with recurrent urolithiasis, finally considered as tertiary HPT, one parathyroid carcinoma (in the fourth parathyroid gland),one thymoma and one occult papillary thyroid carcinoma was identified. Clinical and biochemical cure was achieved at median term control of 38 (range 2–150) months in 85% (n=29) of cases.

Conclusion: Parathyroidectomy is effective for long intervals as symptomatic therapy in cases of RHPT appearing in uremic patients on hemodialysis or after renal transplant but the optimal technique must be individualised on each case and still to be debated.