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Titolo:
Long-term results of total parathyroidectomy without autotransplantation in patients with and without renal failure - An argument for total parathyroidectomy alone
Autore:
Hampl, H; Steinmuller, T; Frohling, P; Naoum, C; Leder, K; Stabell, U; Schnoy, N; Jehle, PM;
Indirizzi:
KfH Dialysis Ctr, Berlin, Germany KfH Dialysis Ctr Berlin GermanyKfH Dialysis Ctr, Berlin, Germany Univ Hosp Rudolf Virchow, Berlin, Germany Univ Hosp Rudolf Virchow Berlin Germany Rudolf Virchow, Berlin, Germany Private Ctr Nephrol, Potsdam, Germany Private Ctr Nephrol Potsdam Germany ivate Ctr Nephrol, Potsdam, Germany Inst Nucl Med, Berlin, Germany Inst Nucl Med Berlin GermanyInst Nucl Med, Berlin, Germany Univ Ulm, Div Nephrol, Ulm, Germany Univ Ulm Ulm GermanyUniv Ulm, Div Nephrol, Ulm, Germany
Titolo Testata:
MINERAL AND ELECTROLYTE METABOLISM
fascicolo: 3, volume: 25, anno: 1999,
pagine: 161 - 170
SICI:
0378-0392(199905/06)25:3<161:LROTPW>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
ADYNAMIC BONE-DISEASE; VITAMIN-D DEFICIENCY; GROWTH-FACTOR SYSTEM; SECONDARY HYPERPARATHYROIDISM; SUBTOTAL PARATHYROIDECTOMY; HEMODIALYSIS-PATIENTS; SERUM LEVELS; OSTEOMALACIA; ALUMINUM; UREMIA;
Keywords:
total parathyroidectomy without autotransplantation; renal insufficiency; secondary hyperparathyroidism; hypoparathyroidism; atherosclerosis;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
65
Recensione:
Indirizzi per estratti:
Indirizzo: Hampl, H Kuratorium Dialyse & Nierentransplantat EV, Bismarckstr 97-98, D-10625 Berlin, Germany Kuratorium Dialyse & Nierentransplantat EV Bismarckstr 97-98 Berlin Germany D-10625
Citazione:
H. Hampl et al., "Long-term results of total parathyroidectomy without autotransplantation in patients with and without renal failure - An argument for total parathyroidectomy alone", MIN ELECT M, 25(3), 1999, pp. 161-170

Abstract

The optimal surgical procedure for severe renal secondary hyperparathyroidism (sHPT) is still a point of controversy. Total parathyroidectomy (PTX) without autotransplantation was abandoned for fear of an adynamic bone condition; however, in the case of autotransplantation recurrent sHPT is frequent and promotes atherosclerosis. We studied 11 hemodialysis patients (age 59+/- 12 years) on dialysis for 18 (12-30) years in whom total PTX was performed due to severe sHPT (group I; intact PTH: 1,240 +/- 230 pg/ml), and 5 patients (age 55 +/- 10 years) without renal insufficiency who inadvertentlyreceived total PTX during thyroid surgery (group II). After total PTX (group 1, 26 +/- 18 [9-59] months; group II, 252 +/- 188 [22-480] months) both groups showed no measurable intact PTH levels. Calcium homeostasis was maintained by oral substitution with calcium (group I, calcium dialysate of 2.0mmol/l), vitamin D and calcitriol (serum parameters in groups I and II: calcium 2.4 and 2.2 mmol/l; phosphate 1.8 and 1.1 mmol/l; 25(OH)-vitamin D-3 21 and 34 ng/ml; 1,25(OH)(2)-vitamin D-3 32 and 41 pg/ml, respectively). Ingroup I, after total PTX there was a rapid and sustained improvement in bone pain with markedly enhanced physical activity and endurance. High turnover osteopathy markedly improved as indicated by declining levels of native osteocalcin (90 +/- 17 vs. 26 +/- 18 ng/ml), bone alkaline phosphatase (74 /- 12 vs. 12 +/- 6 ng/ml), and carboxyterminal crosslinked telopeptide of type-I collagen (65 +/- 16 vs. 40 +/- 21 ng/ml) but increasing levels of carboxyterminal propeptide of type-I procollagen (120 +/- 36 vs. 148 +/- 41 ng/ml). Recalcification of bone was excellent as demonstrated by X-ray and confirmed by bone histology. Itching extravascular calcific deposits and calcifications of blood vessel and cardiac valves immediately stopped after total PTX. Moreover, 6 sHPT patients suffered from severe atherosclerotic lesions such as thoracic aortic aneurysm (n=3) or abdominal aortic aneurysm (n=3) which showed size progression before but not after total PTX when annually controlled by ultrasonography. In group II, even long after total PTX, there was no clinical, radiological, histological or biochemical evidence for low turnover osteopathy. In conclusion, our data indicate that substitution with vitamin D-3 metabolites and calcium can prevent deleterious bone effects of hypoparathyroidism in hemodialysis patients and in patients with normal kidney function and may compensate for the missing PTH action. Over this, a better survival rate is expected as a consequence of the beneficialeffect of total PTX on the progression of atherosclerotic lesions. We suggest reconsideration of total PTX without autotransplantation in dialysis patients with severe sHPT who are not eligible for renal transplantation.

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Documento generato il 10/07/20 alle ore 09:00:04