Revista medica de Chile · 2015
[Surgical treatment of renal hyperparathyroidism. Experience in 71 patients].
Клиническое исследованиеАннотация на английскомСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Pulgar B Dahiana, Jara C Aquiles, González V Gilberto, González D Hernán
Аннотация
BACKGROUND: Surgery is an effective method for the management of renal hyperparathyroidism.
AIM: To report the clinical presentation and results of surgical treatment of renal hyperparathyroidism.
MATERIAL AND METHODS: Retrospective analysis of 58 patients aged 46 ± 11 years with secondary hyperparathyroidism (HPT2) and 13 patients aged 53 ± 11 years with tertiary hyperparathyroidism (HPT3), operated at a clinical hospital.
RESULTS: In 55 cases (77.4%) the indications for surgery were complications of excess parathyroid hormone (PTH) and in 16 patients (22.6%) a failure of medical treatment. Total parathyroidectomy with intraoperative measurement of PTH (PTHop) plus a forearm parathyroid autograft was performed in 54 (93.1%) patients with HPT2 and in all patients with HPT3. PTHop decreased ≥ 75% in 51 patients (88%) with HPT2 and in 9 patients (69.2%) with HPT3, respectively. Cure of the disease was achieved in 52 (89.7%) and 11 (84.6%) patients with HPT2 and 3, respectively. Median follow-up was 41 months. Five (9.6%) patients with HPT2 and two patients (18.2%) with HPT3 had a recurrence of the disease.
CONCLUSIONS: In patients with renal hyperparathyroidism, the primary indication for surgery was the presence of complications of PTH excess. A drop in PTHop ≥ 75% from baseline predicts healing in 98% and 100% of cases with secondary or tertiary HPT respectively. Surgery was a safe and effective treatment in both groups.
AIM: To report the clinical presentation and results of surgical treatment of renal hyperparathyroidism.
MATERIAL AND METHODS: Retrospective analysis of 58 patients aged 46 ± 11 years with secondary hyperparathyroidism (HPT2) and 13 patients aged 53 ± 11 years with tertiary hyperparathyroidism (HPT3), operated at a clinical hospital.
RESULTS: In 55 cases (77.4%) the indications for surgery were complications of excess parathyroid hormone (PTH) and in 16 patients (22.6%) a failure of medical treatment. Total parathyroidectomy with intraoperative measurement of PTH (PTHop) plus a forearm parathyroid autograft was performed in 54 (93.1%) patients with HPT2 and in all patients with HPT3. PTHop decreased ≥ 75% in 51 patients (88%) with HPT2 and in 9 patients (69.2%) with HPT3, respectively. Cure of the disease was achieved in 52 (89.7%) and 11 (84.6%) patients with HPT2 and 3, respectively. Median follow-up was 41 months. Five (9.6%) patients with HPT2 and two patients (18.2%) with HPT3 had a recurrence of the disease.
CONCLUSIONS: In patients with renal hyperparathyroidism, the primary indication for surgery was the presence of complications of PTH excess. A drop in PTHop ≥ 75% from baseline predicts healing in 98% and 100% of cases with secondary or tertiary HPT respectively. Surgery was a safe and effective treatment in both groups.
Предметные рубрики MeSH
AdultBone Diseases, MetabolicFemaleFollow-Up StudiesHumansHypercalcemiaHyperparathyroidism, SecondaryMaleMiddle AgedParathyroid HormoneParathyroidectomyPostoperative ComplicationsPreoperative PeriodRenal DialysisRenal Insufficiency, ChronicRetrospective StudiesTransplantation, AutologousTreatment Outcome