Document Detail

Total parathyroidectomy without autotransplantation for the treatment of secondary hyperparathyroidism associated with chronic kidney disease: clinical and laboratory long-term follow-up.
MedLine Citation:
PMID:  20435429     Owner:  NLM     Status:  MEDLINE    
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 (p < 0.0001). 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.
M Puccini; A Carpi; A Cupisti; R Caprioli; P Iacconi; M Barsotti; P Buccianti; J Mechanick; A Nicolini; P Miccoli
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Publication Detail:
Type:  Journal Article     Date:  2009-10-23
Journal Detail:
Title:  Biomedicine & pharmacotherapy = Biomédecine & pharmacothérapie     Volume:  64     ISSN:  1950-6007     ISO Abbreviation:  Biomed. Pharmacother.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-31     Completed Date:  2010-09-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8213295     Medline TA:  Biomed Pharmacother     Country:  France    
Other Details:
Languages:  eng     Pagination:  359-62     Citation Subset:  IM    
Copyright Information:
2009 Elsevier Masson SAS. All rights reserved.
Department of Surgery, AOUP, S. Chiara Hospital, Pisa, Italy.
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MeSH Terms
Follow-Up Studies
Hospitals, University
Hyperparathyroidism, Secondary / etiology,  surgery*
Kidney Failure, Chronic / complications*
Kidney Transplantation / methods
Middle Aged
Parathyroid Hormone / metabolism
Parathyroidectomy / methods*
Postoperative Complications / epidemiology
Severity of Illness Index
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Parathyroid Hormone

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