Reoperation for persistent or recurrent secondary hyperparathyroidism

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Abstract

Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates.Methods and Results: 4 patients experiencedpersistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, and 4 an hyperplasia of the residual glandular tissue. A classic cervicotomy was sufficient to remove the residual parathyroid in patients with persistent hyperparathyroidism. For cases of recurrent hyperparathyroidism it was enough a medial approach and sometimes lateral for the complete excision of the hyperplastic tissue. The advent of the intraoperative technique of parathyroid hormone dosage allowed a better performance of the surgical technique for the last 3 patients undergoing reoperation. After reoperation all patients had immediate regression of clinical symptoms with normalization of serum calcium and PTH levels. Conclusions: On the basis of these considerations, diagnostic imaging has a not negligible role because during the first intervention helps to have an idea of the possible location of the glands and thus to avoid the risk of recurrence and relapse due to ectopic or supernumerary tissue.
Original languageEnglish
Pages (from-to)325-328
Number of pages4
JournalACTA BIO-MEDICA DE L'ATENEO PARMENSE
Volume88
Publication statusPublished - 2017

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Secondary Hyperparathyroidism
Reoperation
Recurrence
Hyperparathyroidism
Hyperphosphatemia
Parathyroidectomy
Vitamin D Deficiency
Autologous Transplantation
Diagnostic Imaging
Parathyroid Hormone
Chronic Kidney Failure
Hyperplasia
Calcium
Serum

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{da4b214b64be456db55b52103706eea5,
title = "Reoperation for persistent or recurrent secondary hyperparathyroidism",
abstract = "Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates.Methods and Results: 4 patients experiencedpersistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, and 4 an hyperplasia of the residual glandular tissue. A classic cervicotomy was sufficient to remove the residual parathyroid in patients with persistent hyperparathyroidism. For cases of recurrent hyperparathyroidism it was enough a medial approach and sometimes lateral for the complete excision of the hyperplastic tissue. The advent of the intraoperative technique of parathyroid hormone dosage allowed a better performance of the surgical technique for the last 3 patients undergoing reoperation. After reoperation all patients had immediate regression of clinical symptoms with normalization of serum calcium and PTH levels. Conclusions: On the basis of these considerations, diagnostic imaging has a not negligible role because during the first intervention helps to have an idea of the possible location of the glands and thus to avoid the risk of recurrence and relapse due to ectopic or supernumerary tissue.",
author = "Salvatore Buscemi and Giuseppe Buscemi and Alida Abruzzo and Giuseppe Damiano and Gioviale, {Maria Concetta} and {Lo Monte}, {Attilio Ignazio} and Palumbo, {Vincenzo Davide}",
year = "2017",
language = "English",
volume = "88",
pages = "325--328",
journal = "Acta Biomedica de l'Ateneo Parmense",
issn = "0392-4203",
publisher = "L'Ateneo Parmense",

}

TY - JOUR

T1 - Reoperation for persistent or recurrent secondary hyperparathyroidism

AU - Buscemi, Salvatore

AU - Buscemi, Giuseppe

AU - Abruzzo, Alida

AU - Damiano, Giuseppe

AU - Gioviale, Maria Concetta

AU - Lo Monte, Attilio Ignazio

AU - Palumbo, Vincenzo Davide

PY - 2017

Y1 - 2017

N2 - Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates.Methods and Results: 4 patients experiencedpersistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, and 4 an hyperplasia of the residual glandular tissue. A classic cervicotomy was sufficient to remove the residual parathyroid in patients with persistent hyperparathyroidism. For cases of recurrent hyperparathyroidism it was enough a medial approach and sometimes lateral for the complete excision of the hyperplastic tissue. The advent of the intraoperative technique of parathyroid hormone dosage allowed a better performance of the surgical technique for the last 3 patients undergoing reoperation. After reoperation all patients had immediate regression of clinical symptoms with normalization of serum calcium and PTH levels. Conclusions: On the basis of these considerations, diagnostic imaging has a not negligible role because during the first intervention helps to have an idea of the possible location of the glands and thus to avoid the risk of recurrence and relapse due to ectopic or supernumerary tissue.

AB - Background: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. When medical treatment fails, subtotal and total parathyroidectomy with autotransplantation are the standard procedures, although both are associated with high recurrence rates.Methods and Results: 4 patients experiencedpersistence and 9 relapse. The first 4 were subjected to reoperation after 6 months for the persistence of symptoms due to the finding of a supernumerary adenomatous gland while the remaining patients at the reoperation showed in 5 cases 2 more glands in over thymic position, and 4 an hyperplasia of the residual glandular tissue. A classic cervicotomy was sufficient to remove the residual parathyroid in patients with persistent hyperparathyroidism. For cases of recurrent hyperparathyroidism it was enough a medial approach and sometimes lateral for the complete excision of the hyperplastic tissue. The advent of the intraoperative technique of parathyroid hormone dosage allowed a better performance of the surgical technique for the last 3 patients undergoing reoperation. After reoperation all patients had immediate regression of clinical symptoms with normalization of serum calcium and PTH levels. Conclusions: On the basis of these considerations, diagnostic imaging has a not negligible role because during the first intervention helps to have an idea of the possible location of the glands and thus to avoid the risk of recurrence and relapse due to ectopic or supernumerary tissue.

UR - http://hdl.handle.net/10447/245317

M3 - Article

VL - 88

SP - 325

EP - 328

JO - Acta Biomedica de l'Ateneo Parmense

JF - Acta Biomedica de l'Ateneo Parmense

SN - 0392-4203

ER -