Endocrine Abstracts

Background: The optimal surgical technique in patients with refractory renal hyperparathyroidism (RHP) on hemodialysis for end stage renal disease is still a point of debates.

The high percentage of recurrences after standard surgical procedures, i.e. subtotal parathyroidectomy (SPtx) and total parathyroidectomy with autotransplantation (TPtx+At) reactualised the practice of total parathyroidectomy (TPtx).

Patients and methods: Forty-three patients with RHP underwent surgery in the last 16 years period. There were 24 SPtx, 6 TPtx+At, both procedures determining 6 recurrences (20.7%) so in the last years TPtx was perfomed in a series of 13 cases (7 males and 6 females, with median age 43.6 – range 22–65 years, and median dialysis time before PTx 8.2 – range 3–13 years. Parameter studies included demographics, preoperative and follow-up laboratory tests, surgical techniques, pathology results and postoperative immediate and medium term results.

Results: Main indications for TPtx were severe bone disease, soft tissue calciphycations, neuromuscular phenomena, grossly elevated iPTH and sometimes hypercalcemia. TPtx was done in 12 patients, the 13th one suffering a completion PTx 1 year after outward exeresis of only two glands. Postoperatively the majority of symptoms markedly improved and the values of calcemia, phosphatemia, and alkaline phosphatase normalised together with low or no measurable level of iPTH. One patient required a reexploration for cervical hematoma but no one presented permanent hypocalcemia or recurrent hyperparathyroidism. Pathology revealed nodular hyperplasia in all the cases, a parathyroid carcinoma of one gland and also a incidentally thyroid papillary microcarcinoma in a completion thyroidectomy.

Conclusions: TPtx alone proves to be an equally safe and successful as another techniques currently used in the management of RHP eliminating the hyperparathyroid status but being superior with regard of recurrences. The procedure is indicated especially in cases with agressive, refractory forms of RHP without the prospect of renal transplantation.