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Recurrent secondary hyperparathyroidism. An argument for total parathyroidectomy
1Department of Surgery, University of Southern California School of Medicine, Los Angeles, USA.
Archives of Surgery (Chicago, Ill. : 1960)
|July 1, 1996
Summary
Recurrent hyperparathyroidism after parathyroid surgery is common in uremic patients. Total parathyroidectomy with autotransplantation has substantial recurrence rates, suggesting alternative surgical approaches may be needed.
Area of Science:
- Nephrology
- Endocrinology
- Surgical Research
Background:
- Secondary hyperparathyroidism is a common complication in patients with chronic kidney disease.
- Autotransplantation following parathyroidectomy is a standard procedure to manage severe secondary hyperparathyroidism.
Purpose of the Study:
- To better define the incidence and causes of recurrent secondary hyperparathyroidism after total parathyroidectomy with autotransplantation.
- To evaluate surgical outcomes and recurrence rates in uremic patients.
Main Methods:
- A review of total parathyroidectomy with autotransplantation was conducted in uremic patients.
- Nine patients treated between 1982 and 1993 underwent autotransplantation into the sternocleidomastoid muscle.
- Recurrence was managed with graft reduction procedures if necessary.
Main Results:
- All patients achieved normocalcemia post-surgery, with an 11% mortality rate.
- 38% of patients developed recurrent hypercalcemia, with 25% requiring reoperation.
- Causes of recurrence included adenoma in the implant and graft hyperplasia.
Conclusions:
- Substantial recurrence rates of secondary hyperparathyroidism are observed after total parathyroidectomy with autotransplantation.
- Recurrence is likely unavoidable in patients with uncorrected renal failure.
- Consideration should be given to performing total parathyroidectomy alone in patients not candidates for imminent renal transplantation.