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Related Concept Videos

The Parathyroid Glands00:59

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
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Chronic Kidney Disease III: Interprofessional Care01:28

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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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Specialized care provided over an extended period is called tertiary care. Usually, a primary or secondary care physician will refer a patient to tertiary care. A patient's maximum physical and mental function is restored in tertiary care, which is caused due to the impact of a chronic illness or condition. Tertiary care aims to achieve the highest level of functioning possible while managing chronic illness. For example, a patient who falls and fractures their hip will need secondary care...
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Hormones and Bone Tissue01:17

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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
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Bone Remodeling01:40

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Bone remodeling is a continuous and balanced process of bone resorption by osteoclasts and bone formation by osteoblasts. In adults, it helps maintain bone mass and calcium homeostasis. While mechanical stress can stimulate turnover as part of the normal maintenance and reparative process, several hormones also regulate bone remodeling.
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Peripheral Artery Disease III: Interprofessional Care01:27

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Generation of Hypoparathyroid Rats via Carbon-Nanoparticle-Assisted Parathyroidectomy
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Tertiary hyperparathyroidism: a review.

V D Palumbo1, V D Palumbo2, G Damiano1

  • 1Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.

La Clinica Terapeutica
|May 6, 2021
PubMed
Summary
This summary is machine-generated.

Tertiary hyperparathyroidism (HPT III) is a condition of excess parathyroid hormone (PTH) after kidney transplants. Surgery is the primary treatment, though the optimal procedure remains debated.

Keywords:
Calcimimeticsmetabolic disturbancesparathyroidec-tomytertiary hyperparathyroidism

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Area of Science:

  • Nephrology
  • Endocrinology
  • Surgical Oncology

Background:

  • Tertiary hyperparathyroidism (HPT III) arises from prolonged secondary hyperparathyroidism, often linked to chronic kidney disease (CKD).
  • Metabolic disturbances in CKD, including hyperphosphatemia and calcitriol deficiency, stimulate parathyroid glands, leading to hyperplasia and excess parathyroid hormone (PTH) secretion.
  • Post-renal transplant, persistent parathyroid hyperplasia can cause continued oversecretion of PTH, even with normal or elevated calcium levels.

Purpose of the Study:

  • To review the pathophysiology, indications for treatment, and surgical management of tertiary hyperparathyroidism (HPT III).
  • To discuss the various surgical procedures available for HPT III and the ongoing controversy regarding the optimal approach.

Main Methods:

  • Review of literature on tertiary hyperparathyroidism, focusing on its development in chronic kidney disease and post-transplant settings.
  • Analysis of common surgical interventions, including total parathyroidectomy with or without autotransplantation, subtotal parathyroidectomy, and limited parathyroidectomy.
  • Consideration of the role of thymectomy in conjunction with parathyroid surgery.

Main Results:

  • Surgical intervention is indicated for persistent hypercalcemia and/or elevated PTH levels in HPT III.
  • Common surgical options include total, subtotal, and limited parathyroidectomies, with the choice often debated.
  • Surgical complications associated with parathyroidectomy for HPT III are infrequent.

Conclusions:

  • Parathyroidectomy is a safe and effective treatment for tertiary hyperparathyroidism (HPT III).
  • The optimal surgical strategy for HPT III, balancing efficacy and potential complications, requires further clarification.
  • Management of HPT III necessitates a thorough understanding of its underlying mechanisms and surgical considerations.