scholarly journals Surgical treatment of patients with secondary hyperparathyroidism in chronic renal failure

2003 ◽  
Vol 49 (6) ◽  
pp. 36-41
Author(s):  
V. N. Smorshchok ◽  
N. S. Kuznetsov ◽  
A. M. Artemova ◽  
L. Ya. Rozhinskaya ◽  
D. G. Beltsevich
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Secondary Hyperparathyroidism ◽  
Clinical Laboratory ◽  
Intraoperative Ultrasound ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Subtotal Parathyroidectomy ◽  
Ultrasound Study ◽  
Made In

The purpose of the study was to define indications for surgical treatment and its scope in patients with secondary hyperparathyroidism in the presence of end-stage chronic renalfailure. The authors examined 80 patients who had a history of long-term procedures of hemo- or peritoneal dialysis. The patients’ mean age was 47±3.2 years. Measurements of the levels of alkaline phosphatase, ionized and total calcium, phosphorus, parathyroid hormone, ultrasound of the parathyroid glands, densitometry and X-ray study were made in all the patients. All the patients received alfacalcidole therapy during different periods of time. Clinical, laboratory, and morphological correlations were made to establish indications for surgical treatment. The sensitivity ofpreoperative ultrasonography was 72.5% and that of intraoperative ultrasound study was as high as 98.4%. The sensitivity of intraoperative revision was 75%. Sixteen of the 20 patients operated on underwent total parathyroidectomy by autografting a fragment of one of the least glands into the muscle. Subtotal parathyroidectomy was made in 3 patients; 3 parathyroid glands were removed in 1. Emergency and planned studies were performed in all the patients. The duration of the patients operated on averaged 14 months. Three patients undergone total parathyroidectomy with autografiing developed signs of hyperparathyroidism following 6, 12, and 13 months, in this connection graft resection was made in these patients. In the follow-up periods of 3 to 6 months, the level of parathyroid hormone became normal after resurgery in 2 of these patients, hypoparathyroidism developed in one patient. Two months after surgery, recurrent secondary hyperthyroidism was detected in 2 of the 3 patients who had undergone subtotal parathyroidectomy (4 and 7 months after the occurrence of signs of transient hypoparathyroidism) and in 1 patient in whom 3 parathyroid glands had been removed. Four of the 20 patients operated on were observed to have hypoparathyroidism that was compensated by calcium preparations and active forms of vitamin D3. Thus, a good result was noted in 70% of the patients after surgical treatment.

scholarly journals SURGICAL ANATOMY OF PARATHYROID GLANDS IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

2015 ◽  
Vol 7 (3) ◽  
pp. 23-28 ◽  
Author(s):  
K Yu Novokshonov ◽  
Y N Fedotov ◽  
V Y Karelin ◽  
T S Pridvizhkin ◽  
R A Chernikov ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Surgical Anatomy ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Thyroid Lobe ◽  
Subtotal Parathyroidectomy ◽  
Carotid Sheath ◽  
Treat Ment ◽  
Gland Tissue ◽  
Surgical Failure

Ectopic or supernumerary parathyroid glands (PTg) can be the reason of surgical failure in treat- ment of secondary hyperparathyroidism in patients, who underwent dialysis. The aim of this study is to estimate the number and localization of PTgs in patients with secondary hyperparathyroidism. We included 165 patients, who underwent total parathyroidectomy with heterotopic autotransplantation of parathyroid gland tissue or subtotal parathyroidectomy. All identified PTgs were separated in two groups: eutopic and ectopic. Preoperative localization was performed by multispiral computed tomog- raphy of neck and mediastinum, neck ultrasonography, two-isotope Tc99 MIBI of PTgs. In postopera- tive period, we estimated the level of parathyroid hormone in the serum and performed morphological verification. There were found 659 PTgs. 12 (7,2%) patients had 3 parathyroid glands, and 11 (6.7%)had 5 PTgs. 4 Ptgs were found in 142 (86,1%) patients. 520 (78,9%) PTgs were eutopic, 139 (21,1%) - ectopic. The most common ectopic place for upper PTgs were paraesophageal and retrotracheal spaces, carotid sheath. Ectopic lower PTgs were most commonly located in the horns of the thymus. All super- numerary PTg were ectopic and often located in area between lower pole of the thyroid lobe and the thymus.Conclusion. During the operation in case when ectopy is suspected, upper PTgs should be located in in paraesophageal and paratracheal areas or in carotid sheath, if it necessary. If lower PTgs is absence, surgery should be completed cervical thymectomy.

scholarly journals Primary Hyperparathyroidism - Case Report of a Female Patient with Hypercalcemic Crisis

2021 ◽  
Vol 5 (6) ◽  
pp. 01-02
Author(s):  
Rizwan Khalid ◽  
Sidra Rizwan
Keyword(s):  
Renal Failure ◽  
Case Report ◽  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Clinical Laboratory ◽  
Parathyroid Glands ◽  
Daily Activities ◽  
Common Cause ◽  
Hypercalcemic Crisis

Primary hyperparathyroidism is a result of increased and uncontrolled function of the parathyroid hormone caused by hyperfunction of one or more parathyroid glands. The cause of hyperfunction of the parathyroid glands could be adenoma, hyperplasia, and carcinoma. Primary Hyper parathyroidism is the most common cause of Hypercalcemia in outpatient population. The paper presents the case report of a 60years old female treated in our Hospital in March 2013. She presented in outpatient department with complaints of joints pain, Hypertension and renal failure for last 8years. After clinical, laboratory and radiological examination she was diagnosed as a case of PHPT due to a Giant Parathyroid Adenoma. After supportive, symptomatic and surgical treatment, the patient was back to normal daily activities without any signs of disease.

scholarly journals Surgical Treatment of Secondary Hyperparathyroidism at Ectopic Parathyroid Gland in Anterior-Superior Mediastinum (Literature Review and Clinical Case)

2020 ◽  
Vol 5 (4) ◽  
pp. 84-89
Author(s):  
E. A. Ilyicheva ◽  
D. A. Bulgatov ◽  
A. V. Zharkaya ◽  
V. N. Makhutov ◽  
E. G. Grigoryev
Keyword(s):  
Chronic Kidney Disease ◽  
Surgical Treatment ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Clinical Case ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Special Equipment ◽  
Superior Mediastinum

Parathyroidectomy is the leading treatment for drug-refractory secondary and tertiary hyperparathyroidism in patients with chronic kidney disease. Difficulties in performing this surgery are mainly associated with the anatomical features of the parathyroid glands, in particular with the variability of their number and topographic anatomy. Ectopic parathyroid glands are one of the most common causes of persistence or recurrence of secondary hyperparathyroidism after surgery. One of the common variants of ectopia is the localization of the parathyroid gland in the anterior-superior mediastinum. The article discusses the features of surgical treatment of secondary hyperparathyroidism in patients with end-stage chronic kidney disease with this ectopia. A new method of treating hyperparathyroidism in patients with an atypical location of the parathyroid gland in the anterior-superior mediastinum is presented. This method is characterized by low invasiveness of access, ease of implementation without using special equipment and instruments. The proposed method was used in the treatment of a patient with secondary hyperparathyroidism due to chronic renal failure as a result of chronic glomerulonephritis. The duration of hemodialysis at the time of the surgery was more than 17 years. In the presented clinical case, ectopia of one of the pathologically altered parathyroid glands in the anterior-superior mediastinum was found at the preoperative stage. As a method of surgical treatment, we carried out total parathyroidectomy with autotransplantation of a fragment of parathyroid tissue into the brachioradialis muscle. Thanks to this method, it was possible to remove the atypically located parathyroid gland from the cervicotomy access and to discharge the patient within the standard terms for a given volume of surgery.

scholarly journals Multiglandular Parathyroid Disease: the Results of Surgical Treatment

2020 ◽  
Vol 5 (4) ◽  
pp. 90-97
Author(s):  
E. A. Ilyicheva ◽  
G. A. Bersenev ◽  
A. V. Zharkaya ◽  
D. A. Bulgatov ◽  
V. N. Makhutov
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Intraoperative Monitoring ◽  
Parathyroid Glands ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Multiple Lesions ◽  
Multiple Gland Disease

Background. Sporadic multiple gland disease in primary hyperparathyroidism occurs in 7 to 33 % of cases. The absence of specific risk factors, low sensitivity of imaging methods, and low efficiency of bilateral neck exploration and intraoperative monitoring of parathyroid hormone indicate the complexity of the diagnosis and treatment of this disease’s form. Aim of the research. To analyze the results of surgical treatment of multiple lesions of the parathyroid gland in primary and secondary hyperparathyroidism. Methods. There was retrospective study, which included 100 observations of surgical treatment for primary and secondary hyperparathyroidism in the thoracic department of Irkutsk Regional Clinical Hospital from May 2018 to September 2019. The main point was to identify the frequency of surgical treatment outcomes in patients with multiple parathyroid lesions. As part of the study, potential predictors of multiple gland disease in primary hyperparathyroidism were analyzed. Results. Multiple gland disease in primary hyperparathyroidism occurs in 29 % of cases and causes persistence of the disease (p ≤ 0.01). Signs of multiple gland disease in primary hyperparathyroidism include the level of ionized calcium, parathyroid hormone (p ≤ 0.05), creatinine level and glomerular filtration rate (p ≤ 0.01). A negative result of intraoperative monitoring correlates with persistence of primary hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05). Selective parathyroidectomy is associated with persistence of hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05), while total parathyroidectomy is associated with remission of the disease (χ2, p ≤ 0.05). We did not find a statistically significant relationship between the results of surgical treatment for morphology of the parathyroid glands (χ2, p > 0.1). Conclusion. Multiple gland disease is the main cause of persistence of primary hyperparathyroidism. This form of the disease corresponds to lower levels of calcium, parathyroid hormone, and kidney function. Persistence factors have been established: removal of less than four parathyroid glands and a negative result of intraoperative monitoring of parathyroid hormone. Bilateral neck exploration does not reduce the incidence of disease persistence.

scholarly journals Parathyroidectomia: treatment of secondary hyperparathyroidism. Causes and prophylaxis of disease relapse

2011 ◽  
Vol 18 (4) ◽  
pp. 170-174
Author(s):  
V. BEIŠA ◽  
K. LAGUNAVIČIUS ◽  
A. BEIŠA ◽  
K. STRUPAS
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Ultrasound Examination ◽  
Single Photon ◽  
Photon Emission ◽  
Parathyroid Glands ◽  
Emission Computed Tomography ◽  
Mibi Scintigraphy

Background. The growing number of haemodialysis patients and the increasing their life expectancy within the past few years have resulted in a rise of long-term haemodialysis-associated complications. The aim of the paper is to present a case study of a successful surgical treatment of secondary hyperthyroidism and assess the causes of the disease. Materials and methods. A 63-year-old male patient had been on haemodialysis for 18 years; he had undergone parathyroidectomy for secondary hyperparathyroidism 10 years ago. The relapse of the disease was suspected when the patient developed the onset of pruritus and muscle pain. The following tests were performed: biochemical markers of plasma calcium and parathyroid hormone, thyroid ultrasound examination, parathyroid gland 99 mTc MIBI scintigraphy, single photon emission computed tomography of the neck and mediastinum. Results. Elevated calcium (2.73 mmol/l serum) and parathyroid hormone (1352 pg/ml blood plasma) levels were found. Ultrasound examination, 99 mTc MIBI scintigraphy and SPECT revealed parathyroid adenoma of the left inferior thyroid section. The patient underwent surgery in 2011. Remnants of the previously resected parathyroid gland were removed, and an accessory parathyroid gland was found within the thymus; this gland was removed, and partial autotransplantation was performed. The level of the parathyroid hormone decreased to 24 pg/ml during the day after surgery. The histological examination of the removed tissues was performed. Conclusions. Accessory parathyroid glands are usually found within the thymus; therefore, any type of surgical treatment of secondary hyperparathyroidism should include thymectomy. Keywords: parathyroid glands, secondary hyperparathyroidism, haemodialysis, parathyroidectomy

scholarly journals Relationship between parathyroid calcium-sensing receptor expression and potency of the calcimimetic, cinacalcet, in suppressing parathyroid hormone secretion in an in vivo murine model of primary hyperparathyroidism

2005 ◽  
Vol 153 (4) ◽  
pp. 587-594 ◽  
Author(s):  
Takehisa Kawata ◽  
Yasuo Imanishi ◽  
Keisuke Kobayashi ◽  
Takao Kenko ◽  
Michihito Wada ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Murine Model ◽  
Hormone Secretion ◽  
Suppressive Effect ◽  
Receptor Expression ◽  
Parathyroid Glands ◽  
Calcium Sensing Receptor ◽  
Calcium Sensing

Cinacalcet HCl, an allosteric modulator of the calcium-sensing receptor (CaR), has recently been approved for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis, due to its suppressive effect on parathyroid hormone (PTH) secretion. Although cinacalcet’s effects in patients with primary and secondary hyperparathyroidism have been reported, the crucial relationship between the effect of calcimimetics and CaR expression on the parathyroid glands requires better understanding. To investigate its suppressive effect on PTH secretion in primary hyperparathyroidism, in which hypercalcemia may already have stimulated considerable CaR activity, we investigated the effect of cinacalcet HCl on PTH-cyclin D1 transgenic mice (PC2 mice), a model of primary hyperparathyroidism with hypo-expression of CaR on their parathyroid glands. A single administration of 30 mg/kg body weight (BW) of cinacalcet HCl significantly suppressed serum calcium (Ca) levels 2 h after administration in 65- to 85-week-old PC2 mice with chronic biochemical hyperparathyroidism. The percentage reduction in serum PTH was significantly correlated with CaR hypo-expression in the parathyroid glands. In older PC2 mice (93–99 weeks old) with advanced hyperparathyroidism, serum Ca and PTH levels were not suppressed by 30 mg cinacalcet HCl/kg. However, serum Ca and PTH levels were significantly suppressed by 100 mg/kg of cinacalcet HCl, suggesting that higher doses of this compound could overcome severe hyperparathyroidism. To conclude, cinacalcet HCl demonstrated potency in a murine model of primary hyperparathyroidism in spite of any presumed endogenous CaR activation by hypercalcemia and hypo-expression of CaR in the parathyroid glands.

Secondary Hyperparathyroidism

2019 ◽  
Author(s):  
Anna C Beck ◽  
Sonia L Sugg
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Secondary Hyperparathyroidism ◽  
Total Parathyroidectomy ◽  
Indications For Surgery ◽  
Subtotal Parathyroidectomy ◽  
Diagnostic Work ◽  
Work Up ◽  
Hungry Bone ◽  
Diagnostic Work Up

Secondary hyperparathyroidism is defined and its pathophysiology, delineated. Key components of the diagnostic work-up, medical management, and indications for surgery are described. The operative approach and controversy on extent of parathyroidectomy are discussed. This review contains 3 figures, 1 tables, and 24 references.  Key Words: autotransplantation, calciphylaxis, chronic renal failure, cryopreservation, hungry bone syndrome, hypocalcemia, secondary hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy

Secondary Hyperparathyroidism

2019 ◽  
Author(s):  
Anna C Beck ◽  
Sonia L Sugg
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Secondary Hyperparathyroidism ◽  
Total Parathyroidectomy ◽  
Indications For Surgery ◽  
Subtotal Parathyroidectomy ◽  
Diagnostic Work ◽  
Work Up ◽  
Hungry Bone ◽  
Diagnostic Work Up

Secondary hyperparathyroidism is defined and its pathophysiology, delineated. Key components of the diagnostic work-up, medical management, and indications for surgery are described. The operative approach and controversy on extent of parathyroidectomy are discussed. This review contains 3 figures, 1 tables, and 24 references.  Key Words: autotransplantation, calciphylaxis, chronic renal failure, cryopreservation, hungry bone syndrome, hypocalcemia, secondary hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy

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