Robotic thoracoscopic parathyroidectomy for ectopic mediastinal parathyroid adenoma

The publication presents the successful experience of using the DaVinci robotic system for the treatment of persistent hyperparathyroidism caused by mediastinal ectopic parathyroid adenoma in 62 years old female patient. The role of single photon emission computed tomography in diagnostics was demonstrated.

Therapy for persistent hypercalcemic hyperparathyroidism post-renal transplant: cinacalcet versus parathyroidectomy

ABSTRACT Background: Persistent hyperparathyroidism post-transplant is associated with increases in the incidence of cardiovascular events, fractures, and deaths. The aim of this study was to compare both therapeutic options available: parathyroidectomy (PTX) and the calcimimetic agent cinacalcet. Methods: A single center retrospective study including adult renal transplant recipients who developed hypercalcemia due to persistent hyperparathyroidism. Inclusion criteria: PTH > 65 pg/mL with serum calcium > 11.5 mg/dL at any time after transplant or serum calcium persistently higher than 10.2 mg/dL one year after transplant. Patients treated with cinacalcet (n=46) were compared to patients treated with parathyroidectomy (n=30). Follow-up period was one year. Clinical and laboratory data were analyzed to compare efficacy and safety of both therapeutic modalities. Results: PTX controlled calcemia faster (month 1 x month 6) and reached significantly lower levels at month 12 (9.1±1.2 vs 9.7±0.8 mg/dL, p < 0.05); PTX patients showed significantly higher levels of serum phosphate (3.8±1.0 vs 2.9±0.5 mg/dL, p < 0.05) and returned PTH to normal levels (45±51 pg/mL). Cinacalcet, despite controlling calcium and phosphate in the long term, decreased but did not correct PTH (197±97 pg/mL). The proportion of patients that remained with PTH above normal range was 95% in the cinacalcet group and 22% in the PTX group. Patients treated with cinacalcet had better renal function (creatinine 1.2±0.3 vs 1.7±0.7 mg/dL, p < 0.05). Conclusions: Surgical treatment was superior to cinacalcet to correct the metabolic disorders of hyperparathyroidism despite being associated with worse renal function in the long term. Cinacalcet proved to be a safe and well tolerated drug.

Persistent Hyperparathyroidism Post- Kidney Transplantation: A Single Center Experience

Background and aim: Persistent hyperparathyroidism after renal transplantation, termed tertiary hyperparathyroidism, is not uncommon. We aimed to identify the prevalence of persistent hyperparathyroidism after successful kidney transplantation and to study the associated risk factors. Methods: This is a cross-sectional study including 63 patients who underwent renal transplantation for the first time &for at least a year. Data was collected about demographic characteristics, duration of chronic kidney disease& dialysis therapy, history of hypertension, diabetes mellitus, coronary heart disease and use of medications including vitamin D. Levels of serum calcium and phosphate and renal function test were recorded prior and post- transplantation. Serum parathyroid hormone was tested only post- transplantation. The association of those variable with hyperparathyroidism was studied by Pearson’s correlation. P≤0.05 was considered statistically significant. Results: Hyperparathyroidism was found in 53 (84.10%) patients, there was a strong positive correlation of parathyroid hormone level and serum levels of calcium and phosphate with (p-value<0.001). While the correlation was negative of parathyroid hormone level and estimated glomerular filtration rate after transplantation. None of the variables apart from hypertension was strongly associated as a risk factor before transplantation for persistant hyperparathyroidism. Conclusions: In this single center study; more than 80% of post-transplant patients with normal transplant function, have elevated levels of parathyroid hormone more than one year after transplantation. This may have a major impact on clinical treatment guidelines. However, no association was observed between pre-transplant age, duration of transplant, duration on dialysis as risk factors for persistent hyperparathyroidism.