Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: Clinical and laboratory long-term follow-up
| Autor: | Andrea Nicolini, Marco Puccini, Pietro Iacconi, Paolo Miccoli, Jeffrey I. Mechanick, Massimiliano Barsotti, Piero Buccianti, Angelo Carpi, Adamasco Cupisti, R Caprioli |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Parathyroidectomy medicine.medical_specialty Time Factors medicine.medical_treatment Severity of Illness Index Hospitals University Postoperative Complications Recurrence medicine Humans Bone pain Aged Pharmacology Hyperparathyroidism business.industry General Medicine Perioperative Middle Aged medicine.disease Kidney Transplantation Autotransplantation Surgery Transplantation Treatment Outcome Parathyroid Hormone Kidney Failure Chronic Female Hyperparathyroidism Secondary Secondary hyperparathyroidism medicine.symptom business Follow-Up Studies Kidney disease |
| Zdroj: | Biomedicine & Pharmacotherapy. 64:359-362 |
| ISSN: | 0753-3322 |
| DOI: | 10.1016/j.biopha.2009.06.006 |
| Popis: | Forty-six consecutive patients who underwent total parathyroidectomy (tPTX) for hyperparathyroidism associated with end-stage kidney disease (CKD5) in a University Hospital from 1990 to 1999 were included in a long-term observational study. Outcome parameters included symptoms (bone pain, pruritus and muscle weakness evaluated by visual analog scales [VAS]) and laboratory data (intact parathyroid hormone [iPTH], total calcium, and alkaline phosphatase) assessed before, shortly postoperatively and then at a later time point: 40 patients were on maintenance hemodialysis and six on conservative medical therapy. Forty-four patients had four glands removed, while only three glands were found in the remaining two. Perioperative complications consisted of acute symptomatic hypocalcemia in 10 (22%) patients and non-specific complaints in three (7%). No laryngeal nerve palsies occurred. After a median follow-up of eight years, 43 subjects were evaluated: 37 (86%) were cured, three (7%) had persistent and three (7%) recurrent disease. Eleven patients underwent successful renal transplantation and 23 died during the period of observation. iPTH decreased from a mean of 1084+/-505 pg/ml to 120+/-381 pg/ml (p0.0001). No subsequent bone fractures, persistent bone pain or disability were reported; this includes patients who later received a functioning renal graft. tPTX was able to correct hyperparathyroidism in most of the patients and was associated with a low long-term relapse rate. iPTH levels remained low in 17 cases without symptoms and no clinically significant side effects. The beneficial effects of tPTX occurred in the majority of patients while renal transplantation was performed in a minority of patients. tPTX should be considered a safe and successful procedure for the treatment of severe secondary hyperparathyroidism associated with chronic kidney disease. |
| Databáze: | OpenAIRE |
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