[Secondary hyperparathyroidism. Modern concepts of its diagnosis and treatment. Apropos of 45 cases]

An analysis of different problems raised by secondary hyperparathyroidism. This condition most often follows chronic renal failure responsible for hyperphosphataemia followed by hypocalcaemia which causes parathyroid stimulation with hyperplasia. Clinical features are dominated by osteopathic manifestations and pruritus. The diagnosis is based upon radiological examination of the skeleton, repeated measurement of serum calcium and phosphate levels and above all iliac crest biopsy. Surgical treatment is based essentially on total parathyroidectomy with autologous transplantation of parathyroid tissue into the muscles of the forearm. This is followed by study of 45 cases undergoing surgery with details concerning surveillance and postoperative care. The results were very satisfactory since amongst these 45 patients undergoing total parathyroidectomy, only two continued to suffer from bone pain.