[Indications and efficacy of parathyroidectomy in the treatment of secondary hyperparathyroidism in patients with chronic renal failure: our experience]. / Indicazioni e validità della paratiroidectomia nel trattamento dell'iperparatiroidismo in corso di insufficienza renale cronica: nostra esperienza.

ABSTRACT

Although secondary hyperparathyroidism is improved by pharmacological therapy; 10-30% of patients with chronic renal failure undergo parathyroidectomy. The authors report on their experience with 66 cases of secondary hyperparathyroidism surgically treated over the period from January 1991 to December 2002. The surgical indications included persistent hypercalcaemia, osteodystrophy with bone fractures, joint pain, itching and ectopic calcifications. The median preoperative parathyroid hormone level was 400 pg/ml. The operations performed were subtotal parathyroidectomy (PTX 7/8) in 43 cases; total parathyroidectomy with autotransplantation (PTXt + At) in 13 cases; total parathyroidectomy (PTXt) alone in 6 cases and incomplete parathyroidectomy (PTXi) in 4 cases. The immediate results were satisfactory in each group. Calcium levels reverted to normal 24-48 hours postoperatively in 37 patients with PTX 7/8, in 11 patients with PTXt + At, in 5 patients with PTXt; 4 patients with PTXi showed a reduction, but no normalization, of calcium levels. Almost all patients, except those undergoing PTXi, showed an acceptable reduction in PTH levels in 25-35 days. Secondary hyperparathyroidism relapsed in 3 cases with PTXt + At and in 2 cases with PTX 7/8, while it proved persistent in 50% of patients with PTXi and in 7% of patients with PTX 7/8. Patients with PTXt mainly showed a substantial reduction of calcium levels. Parathyroidectomy is indispensable for the treatment of secondary hyper-parathyroidism. In our opinion, PTX 7/8 is the surgical treatment of choice because it is the easiest technique to perform and has the lowest relapse rate.