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Tertiary Hyperparathyroidism: Why the Delay?

Sophie Dream1, Herbert Chen2, Brenessa Lindeman2

  • 1Medical College of Wisconsin, Milwaukee, WI 53266.

Annals of Surgery
|June 17, 2020
PubMed
Summary
This summary is machine-generated.

Patients with tertiary hyperparathyroidism (THPT) often wait a year for parathyroidectomy referral. Earlier surgical referral for THPT improves renal allograft function, indicated by better creatinine levels.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Surgical Oncology

Background:

  • Persistent hyperparathyroidism post-renal transplant negatively impacts allograft function.
  • Referral for definitive treatment of tertiary hyperparathyroidism (THPT) is frequently delayed.
  • Understanding reasons for delay is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To evaluate the reasons for delayed surgical referral in tertiary hyperparathyroidism (THPT) after renal transplantation.
  • To assess the impact of delayed referral on renal allograft function.

Main Methods:

  • Retrospective review of 38 patients undergoing parathyroidectomy for THPT.
  • Recorded time from first elevated serum calcium post-transplant to parathyroidectomy referral.
  • Assessed allograft function using pre- and post-operative creatinine levels.

Main Results:

  • Median referral time for parathyroidectomy was 320 days.
  • Over 50% of referrals were delayed due to issues with cinacalcet (cost, control, compliance).
  • Early referral (<278 days) was associated with a significant improvement in creatinine (27.6% vs -5%, P = 0.007).

Conclusions:

  • Patients with THPT experience significant delays (approx. 1 year) in referral for parathyroidectomy.
  • Earlier surgical referral for THPT is linked to improved renal allograft function.
  • Addressing barriers to timely referral can enhance post-transplant outcomes.