Trattamento chirurgico dell’iperparatiroidismo secondario. Studio clinico in 70 pazienti.

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COD: 06_2010_413-420 Categoria:

Giovanni Conzo, Antonietta Palazzo, Cristina Della Pietra, Francesco Stanzione, Giuseppe Candilio, Giovanni Docimo, Antonio Livrea

Ann. Ital. Chir., 2010 81: 413-419

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AIM: The Authors analyze the short and long-term results of surgical treatment in 70 consecutive patients operated on
from for secondary Hyperparathyroidism (2HPT) of chronic kidney disease (CKD).
MATERIAL OF STUDY: Seventy patients affected by 2HPT of CKD, in hemodialytic treatment, were observed from January
1999 to January 2009. Twentyseven patients were submitted to total parathyroidectomy (TP), 36 pts were submitted to
total parathyroidectomy plus subcutaneous autoimplantation (TP ai), 7 pts were submitted to subtotal parathyroidectomy
(SP).
RESULTS: An improvement of the typical clinical symptoms was found in every patient undergoing surgery, and a significant
reduction in intact parathyroid hormone (iPTH) serum levels was achieved. TP determined a lower incidence
of one year relapse. After TPai 9/36 pts successfully underwent renal transplantation.
DISCUSSION: To date surgical treatment of 2HPT is still controversial. SP and TPai are the most commonly adopted
surgical interventions while TP had been previously been confined to patients with advanced dialytic vintage or for the
treatment of recurrence, for the risks arising from aparathyroidism. TP allows a lower long-term relapse incidence and
managing the resulting hypoparathyroidism appears straightforward with medical treatment.
CONCLUSIONS: The Authors are in favour of early surgical intervention to prevent cardiovascular complications. TPai
may be the operation of choice in patients eligible for kidney transplantation while TP, carachterized by a lower incidence
of long term relapse, is reserved to patients not eligible for transplantation and affected by a more “aggressive”
forms of 2HPT.

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