Results of surgical treatment of renal hyperparathyroidism
E. Neonakis, M. H. Wheeler, H. Krishnan, G. A. Coles, F. Davies and J. S. Woodhead
Department of Surgery, Cardiff Royal Infirmary, Wales.
OBJECTIVE: To assess the outcome of parathyroidectomy for renal
failure-related hyperparathyroidism. DESIGN: A retrospective analysis with
a mean follow-up of 4.34 years of a case series of 67 consecutive patients
with renal failure-associated hyperarathyroidism. SETTING: All patients
were operated on at the University Hospital of Wales and Cardiff Royal
Infirmary between October 1981 and December 1991. PATIENTS: Of the 67
consecutive patients, 35 were receiving hemodialysis and 32 had received a
renal transplant. INTERVENTION: Total parathyroidectomy with
autotransplantation was performed in 52 patients and subtotal
parathyroidectomy was performed in 15. MAIN OUTCOME MEASURES: Symptomatic
improvement after parathyroidectomy, the normalization of biochemical
parameters, and the rate of recurrent hyperparathyroidism after
parathyroidectomy. RESULTS: Symptomatic improvement after parathyroidectomy
occurred in 81% of hemodialysis patients and in 72% of transplant patients.
The best predictor for successful relief of skeletal pain after
parathyroidectomy was an elevated preoperative alkaline phosphatase level.
Recurrent hyperparathyroidism developed in four of 38 patients after total
parathyroidectomy with autotransplantation and in one of 14 surviving
patients after subtotal parathyroidectomy. All five patients with recurrent
disease were hemodialysis patients (22%). CONCLUSIONS: Transplant patients
usually present with less severe disease, have better normalization of
biochemical parameters after parathyroidectomy, and rarely develop
recurrent hyperparathyroidism compared with hemodialysis patients. Both
total parathyroidectomy with autotransplantation and subtotal
parathyroidectomy result in good control of renal hyperparathyroidism with
excellent improvement of symptoms.
