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Results of surgical treatment of renal hyperparathyroidism
E Neonakis1, M H Wheeler, H Krishnan
1Department of Surgery, Cardiff Royal Infirmary, Wales.
Objective:
To assess the outcome of parathyroidectomy for renal failure-related hyperparathyroidism.
Design:
A retrospective analysis with a mean follow-up of 4.34 years of a case series of 67 consecutive patients with renal failure-associated hyperarathyroidism.
Setting:
All patients were operated on at the University Hospital of Wales and Cardiff Royal Infirmary between October 1981 and December 1991.
Patients:
Of the 67 consecutive patients, 35 were receiving hemodialysis and 32 had received a renal transplant.
Intervention:
Total parathyroidectomy with autotransplantation was performed in 52 patients and subtotal parathyroidectomy was performed in 15.
Main Outcome Measures:
Symptomatic improvement after parathyroidectomy, the normalization of biochemical parameters, and the rate of recurrent hyperparathyroidism after parathyroidectomy.
Results:
Symptomatic improvement after parathyroidectomy occurred in 81% of hemodialysis patients and in 72% of transplant patients. The best predictor for successful relief of skeletal pain after parathyroidectomy was an elevated preoperative alkaline phosphatase level. Recurrent hyperparathyroidism developed in four of 38 patients after total parathyroidectomy with autotransplantation and in one of 14 surviving patients after subtotal parathyroidectomy. All five patients with recurrent disease were hemodialysis patients (22%).
Conclusions:
Transplant patients usually present with less severe disease, have better normalization of biochemical parameters after parathyroidectomy, and rarely develop recurrent hyperparathyroidism compared with hemodialysis patients. Both total parathyroidectomy with autotransplantation and subtotal parathyroidectomy result in good control of renal hyperparathyroidism with excellent improvement of symptoms.