scholarly journals Outcome of Total Parathyroidectomy and Autotransplantation as Treatment of Secondary and Tertiary Hyperparathyroidism in Children and Adults

2010 ◽  
Vol 34 (5) ◽  
pp. 993-1000 ◽  
Author(s):  
A. J. Kievit ◽  
J. G. M. Tinnemans ◽  
M. M. Idu ◽  
J. W. Groothoff ◽  
S. Surachno ◽  
...  
Keyword(s):  
Total Parathyroidectomy ◽  
Tertiary Hyperparathyroidism

Tumor-induced rickets-osteomalacia: an enigma

2020 ◽  
Vol 33 (8) ◽  
pp. 1097-1103
Author(s):  
Sandeep Kumar ◽  
Ravikumar Shah ◽  
Virendra Patil ◽  
Swati Ramteke-Jadhav ◽  
Munita Bal ◽  
...  
Keyword(s):  
Fibroblast Growth Factor 23 ◽  
Delayed Diagnosis ◽  
Hypophosphatemic Rickets ◽  
Total Parathyroidectomy ◽  
Elevated Alkaline Phosphatase ◽  
Case Presentation ◽  
Tertiary Hyperparathyroidism ◽  
Biochemical Evaluation ◽  
Surgical Corrections ◽  
Normal Calcium

AbstractObjectivesWe report a case of pediatric thoracic tumor-induced osteomalacia (TIO) causing severe hypophosphatemic rickets with delayed diagnosis and emphasize on timely management of this rare entity.Case presentationA young boy presented with rickets since five years of age. Biochemical evaluation revealed hypophosphatemia, hyperphosphaturia, elevated alkaline phosphatase and normal calcium levels. Initially managed as hereditary hypophosphatemic rickets, he was given phosphorus supplements and calcitriol. Despite the therapy, skeletal deformities worsened requiring surgical corrections. Subsequently, he developed iatrogenic tertiary hyperparathyroidism for which he underwent total parathyroidectomy. Later on, he was found to have fibroblast growth factor-23 secreting thoracic mass (10.5 cm in largest dimension) which was excised with significant post operative improvement. Histopathology showed phosphaturic mesenchymal tumor-mixed connective tissue variant, confirming the diagnosis of TIO.ConclusionTIO, a correctable cause of hypophosphatemic rickets, should be considered in children presenting with hypophosphatemic rickets with evident mass on examination/imaging and in refractory cases.

Near Total Parathyroidectomy is Effective Therapy for Tertiary Hyperparathyroidism

2014 ◽  
Vol 80 (7) ◽  
pp. 646-651 ◽  
Author(s):  
Lindel Krige Dewberry ◽  
Collin Weber ◽  
Jyotirmay Sharma
Keyword(s):  
Glomerular Filtration Rate ◽  
Renal Transplantation ◽  
Filtration Rate ◽  
Surgical Intervention ◽  
Total Parathyroidectomy ◽  
Current Standard ◽  
Tertiary Hyperparathyroidism ◽  
All Cause Mortality ◽  
Persistent Hyperparathyroidism

Tertiary hyperparathyroidism (3°HPT) is defined as persistent hyperparathyroidism with hypercalcemia after renal transplantation. Near total parathyroidectomy (NTPTX) is the current standard for surgical intervention. The purpose of this study was to identify outcomes of NTPTX. A retrospective review was conducted of surgeries performed between 1994 and 2013. NTPTX resulted in resolution of 96.9 per cent of patients’ hypercalcemia at a median follow-up of three years (interquartile range [IQR], 1 to 8). However, 3.1 per cent of patients remained hypercalcemic with a mean calcium of 10.5 ± 0.2 mg/dL. A total of 78.4 per cent of patients had parathyroid hormone (PTH) levels below 250 pg/mL at a median follow-up of two years (IQR, 2 to 8). The remaining 21.6 per cent had a median PTH of 535 (IQR, 345 to 857). PTH levels dropped from a median of 745 (IQR, 285.75 to 1594.25) pg/mL to 97 (IQR, 60 to 285) pg/mL one month post-NTPTX ( P < 0.01). The most frequent complication was transient hypocalcemia in 27.1 per cent of patients, but no patients became permanently hypocalcemic. In the 1-month postoperative period, only one patient had a cardiac complication, and there was 0 per cent all-cause mortality. Glomerular filtration rate fell from 57.9 ± 28.3 mL/min pre-NTPTX to 53.2 ± 27.5 mL/min at 1-year post-NTPTX ( P < 0.01). NTPTX effectively treats hypercalcemia in 3°HPT. However, PTH remains elevated (greater than 250) in 21.6 per cent of patients.

Pattern of Intraoperative Parathyroid Hormone and Calcium in the Treatment of Tertiary Hyperparathyroidism

2019 ◽  
Vol 161 (6) ◽  
pp. 954-959 ◽  
Author(s):  
André Luís Maion Casarim ◽  
Fernando Antonio Maria Claret Arcadipane ◽  
Antonio Santos Martins ◽  
André Del Negro ◽  
André Afonso Nimtz Rodrigues ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Sensitivity And Specificity ◽  
Medical Center ◽  
Characteristic Curve ◽  
Treatment Success ◽  
Case Series ◽  
High Sensitivity ◽  
Total Parathyroidectomy ◽  
Tertiary Hyperparathyroidism ◽  
Intraoperative Pth

Objective Tertiary hyperparathyroidism, an autonomous hyperproduction of parathyroid hormone (PTH), has a challenge in its treatment. This study asked whether the intraoperative PTH and calcium drop can confirm the resection of all parathyroid tissues. Study Design Case series with planned data collection. Setting Tertiary referral medical center. Subjects and Methods The study assessed patients with tertiary hyperparathyroidism who were treated at the Hospital of the State University of Campinas from 2007 to 2015. All patients underwent total parathyroidectomy with autotransplantation of parathyroid fragments. PTH and calcium were collected during the preoperative period; at 10, 20, and 240 minutes after resection of the glands; and at 1 year after the procedure. Data were analyzed by analysis of variance and logistic regression analysis with statistical values of P < .05. Results Thirty-five patients were assessed: 17 women (48.57%) and 18 men (51.43%). The percentage of PTH drop was statistically significant at all times, unlike the calcium analysis, but only PTH collected at 20 minutes was able to confirm the removal of all parathyroid tissues ( P = .029). Based on the receiver operating characteristic curve, the 71.2% drop obtained high sensitivity and specificity ( P = .028). Conclusions Treatment success can be predicted by analyzing the decrease of intraoperative PTH and not by calcium. The 71.2% PTH drop at 20 minutes after parathyroidectomy had high sensitivity and specificity to predict surgical cure.

Total parathyroidectomy and autotransplantation for tertiary hyperparathyroidism in children with chronic renal failure

1984 ◽  
Vol 19 (4) ◽  
pp. 389-393 ◽  
Author(s):  
Farhat Moazam ◽  
John K. Orak ◽  
Robert S. Fennell ◽  
George A. Richard ◽  
James L. Talbert
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Total Parathyroidectomy ◽  
Tertiary Hyperparathyroidism

Total Parathyroidectomy versus Subtotal Parathyroidectomy in the Treatment of Tertiary Hyperparathyroidism

2012 ◽  
Vol 78 (5) ◽  
pp. 600-606 ◽  
Author(s):  
Ting-Min Hsieh ◽  
Cheuk-Kwan Sun ◽  
Yen-Ta Chen ◽  
Fong-Fu Chou
Keyword(s):  
Calcium Level ◽  
Total Parathyroidectomy ◽  
Long Term Outcomes ◽  
Subtotal Parathyroidectomy ◽  
Tertiary Hyperparathyroidism ◽  
Median Serum ◽  
Long Term Follow Up ◽  
Surgical Options

The purposes of this study are to evaluate the merits of surgical treatment, including subtotal parathyroidectomy (SP) and total parathyroidectomy (TP), in patients with tertiary hyperparathyroidism (THPT) and compare the outcome of the two surgical options. Medical records of patients undergoing parathyroidectomy for THPT were retrospectively reviewed and long-term outcomes between the two groups were compared. Fourteen out of 488 renal transplantation recipients required parathyroidectomy for THPT during a 24-year follow-up period with a median follow-up of 35.5 [interquartile range (IQR), 19.3–133.3] months. All patients had hypercalcemia, whereas 13 had varying symptoms and one was asymptomatic. Median serum calcium level decreased from 12.4 (IQR, 11.9–12.6) mg/dL preoperatively to 8.9 (IQR, 8.1–9.4) mg/dL postoperatively ( P = 0.001), whereas median intact parathyroid hormone (iPTH) dropped from a preoperative level of 340.5 (IQR, 247–540) pg/mL to 55.1 (IQR, 24.4–66.4) pg/mL after surgery ( P = 0.018). Comparison between patients receiving TP and SP revealed no difference in incidence of recurrence or permanent complications, whereas the former had significantly lower calcium levels ( P = 0.048) and higher phosphorus levels ( P = 0.017) compared with the latter. Moreover, a significant reduction in calcium level was noted in TP group on long-term follow-up compared with their immediately postoperative level (8.1 vs 9.0 mg/dL, respectively, P < 0.05), whereas there was no significant decrease in SP group. We concluded that parathyroidectomy is efficient and safe in treating THPT. Because TP would increase the risk of hypocalcemia, a less radical procedure (SP) is preferred.

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