Long-term prognosis of parathyroid function for chronic dialysis patients after minimally invasive radioguided parathyroidectomy (MIRP).

BACKGROUND

Minimally invasive radioguided parathyroidectomy (MIRP) for primary hyperparathyroidism for one gland, located by scanning with technetium 99m-labelled sestamibi (MIBI), has been performed. Total parathyroidectomy with autotransplantation or percutaneous ethanol injection therapy (PEIT) for severe secondary hyperparathyroidism (2HPT) has also been performed.

METHODS

The present study examined the possibility of maintaining parathyroid function within a target range [intact parathyroid hormone (i-PTH) <or=300 pg/ml] in the long term after MIRP for 2HPT. Three patients resistant to calcitriol therapy gave their informed consent for MIRP. The principle of MIRP for chronic dialysis patients is to extract a hyper-functioning parathyroid gland resistant to medical therapy, including calcitriol pulse therapy, and then control the remaining glands with medical therapy. The follow-up period for this study was 2 years.

RESULT: Two of the cases were controlled by MIRP followed by calcitriol pulse therapy. In all three cases, MIBI scintigraphy showed a solitary radioactive nodule; however, ultrasonography showed that in the two cases that were controlled by MIRP and calcitriol pulse therapy, there was one radioactive gland, but in the other case there were three, and this case required additional PEIT for control of hyperparathyroidism.