Endocrine Abstracts

Introduction: Hyperparathyroidism is a fairly common pathology that can cause functional and vital complications. Its treatment combines a medical component and a surgical one.

The aim of this work is to specify the surgical indications for this pathology.

Materials and methods: It is a retrospective study bringing 58 cases of secondary hyperparathyroidism collected over a period of 16 years (from 2001 to 2016).

Results: Our series includes 23 women and 25 men with a sex ratio of 1.5. The average age of our patients was 43 years (17 to 78 years).

All patients had chronic renal failure at the hemodialysis stage, progressing for an average duration of 6.77 years. They received medical treatment with calcium and vitamin D.

Bone pain was the most frequent reason for consultation (100 % of cases), followed by muscle fatigue (80 % of cases) and by a pathological fracture in 2 cases.

The diagnosis of hyperparathyroidism was made in front of high PTH figures, associated with hyperphosphoremia and a tendency to hypocalcaemia. Sixty percent of patients retained hypovitaminosis D despite well--managed supplementation.

Seventy-five patients had radiographs of the hands and skull, showing diffuse bone demineralization.

Parathyroid scintigraphy associated with cervical ultrasound, requested in all patients, showed hyper fixation of the thyroid gland in regard in 95% of the cases.

A 7/8 reduction parathyroidectomy was performed in all patients with a drop of more than 50% in PTH levels in all cases.

We noted a clear improvement in functional complaints postoperatively in all patients.

Conclusion: Secondary hyperparathyroidism remains a frequent problem in chronic hemodialysis patients. Its treatment is above all preventive. Surgery is only indicated if medical treatment fails.