open access

Vol 66, No 5 (2015)
Original papers
Published online: 2015-10-12
Submitted: 2014-10-05
Accepted: 2015-01-23
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Assessment of operative treatment of patients with tertiary hyperparathyroidism after kidney transplantation

Jacek Gawrychowski, Ryszard Mucha, Michał Paliga, Henryk Koziołek, Grzegorz Buła
DOI: 10.5603/EP.2015.0052
·
Endokrynologia Polska 2015;66(5):422-427.

open access

Vol 66, No 5 (2015)
Original papers
Published online: 2015-10-12
Submitted: 2014-10-05
Accepted: 2015-01-23

Abstract

Introduction: The purpose of the study was to assess the results of operative treatment of patients with tertiary hyperparathyroidism (tHPT) after kidney transplantation.

Material and methods: The study included 30 patients in whom kidney transplantation was performed between 2006 and 2013, and in whom parathyroidectomy had to be performed at a later time because of tHPT. There were 17 (56.7%) women and 13 (43,3%) men in the group, aged 18–64, mean 46.1 years. In order to locate the lesion before the operation, all patients had to undergo USG, and 14 had scintigraphy MIBI in addition. Serum levels of PTH, ionised calcium, and creatinine were determined together with glomerular filtration rate (GFR). The results of control tests were compared with those performed one day before parathyroidectomy (PTX) and three days after the operation.

Results: Among 30 patients, 19 (63.3%) underwent total resection of three parathyroid glands and 3/4 of the fourth. Two parathyroid glands were resected in eight (26.7%) patients, and one in the remaining three (10%) patients. Histopathological examination showed one parathyroid adenoma in six (20%) patients, and one parathyroid adenoma and hyperplasia of the remaining glands in one (3.3%) patient. Five (16.7%) patients had hyperplasia of two parathyroid glands whereas no changes were observed in two patients. On the other hand, hyperplasia of all glands was noted in 18 (60%) patients. Serum PTH level was significantly lower compared to the level before operation (p < 0.001), being 5.5–58.5 pg/mL, on day 3 postoperatively. Differences in the levels of serum-ionised calcium were also significant (p < 0.0001) after eight months.

Conclusions:

  1. Surgical resection of parathyroid glands is a management of choice in patients after kidney transplantation accompanied by hypercalcaemia lasting longer than one year.
  2. Resection of 3 3/4 parathyroid glands because of hyperplasia in patients with hyperparathyroidism after kidney transplantation enables restoration of normal calcium metabolism.
  3. Moreover, resection of 3 3/4 parathyroid glands can allow avoidance of autotransplantation, which is necessary in cases of total resection of parathyroid glands. (Endokrynol Pol 2015; 66 (5): 422–427)

Abstract

Introduction: The purpose of the study was to assess the results of operative treatment of patients with tertiary hyperparathyroidism (tHPT) after kidney transplantation.

Material and methods: The study included 30 patients in whom kidney transplantation was performed between 2006 and 2013, and in whom parathyroidectomy had to be performed at a later time because of tHPT. There were 17 (56.7%) women and 13 (43,3%) men in the group, aged 18–64, mean 46.1 years. In order to locate the lesion before the operation, all patients had to undergo USG, and 14 had scintigraphy MIBI in addition. Serum levels of PTH, ionised calcium, and creatinine were determined together with glomerular filtration rate (GFR). The results of control tests were compared with those performed one day before parathyroidectomy (PTX) and three days after the operation.

Results: Among 30 patients, 19 (63.3%) underwent total resection of three parathyroid glands and 3/4 of the fourth. Two parathyroid glands were resected in eight (26.7%) patients, and one in the remaining three (10%) patients. Histopathological examination showed one parathyroid adenoma in six (20%) patients, and one parathyroid adenoma and hyperplasia of the remaining glands in one (3.3%) patient. Five (16.7%) patients had hyperplasia of two parathyroid glands whereas no changes were observed in two patients. On the other hand, hyperplasia of all glands was noted in 18 (60%) patients. Serum PTH level was significantly lower compared to the level before operation (p < 0.001), being 5.5–58.5 pg/mL, on day 3 postoperatively. Differences in the levels of serum-ionised calcium were also significant (p < 0.0001) after eight months.

Conclusions:

  1. Surgical resection of parathyroid glands is a management of choice in patients after kidney transplantation accompanied by hypercalcaemia lasting longer than one year.
  2. Resection of 3 3/4 parathyroid glands because of hyperplasia in patients with hyperparathyroidism after kidney transplantation enables restoration of normal calcium metabolism.
  3. Moreover, resection of 3 3/4 parathyroid glands can allow avoidance of autotransplantation, which is necessary in cases of total resection of parathyroid glands. (Endokrynol Pol 2015; 66 (5): 422–427)
Get Citation

Keywords

tertiary hyperparathyroidism; parathyroidectomy

About this article
Title

Assessment of operative treatment of patients with tertiary hyperparathyroidism after kidney transplantation

Journal

Endokrynologia Polska

Issue

Vol 66, No 5 (2015)

Pages

422-427

Published online

2015-10-12

DOI

10.5603/EP.2015.0052

Bibliographic record

Endokrynologia Polska 2015;66(5):422-427.

Keywords

tertiary hyperparathyroidism
parathyroidectomy

Authors

Jacek Gawrychowski
Ryszard Mucha
Michał Paliga
Henryk Koziołek
Grzegorz Buła

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