Erdem KARADENİZ, Ayetullah TEMİZ, Yusuf TANRİKULU

Surgical treatment of secondary hyperparathyroidism

Aim: Initial treatment of secondary hyperparathyroidism (sHPT), often seen as a result of end-stage renal failure, is medicaltreatment. Treatment-resistant patients require surgery. The aim of this study is to evaluate the diagnosis and treatment of patientswho underwent sHPT.Material and Methods: Twenty-one patients who were operated for sHPT were included in the study. The demographic data of thepatients and correlation of imaging results with correct localization and pathological diagnosis were evaluated.Results: The mean age of the patients was 45.80±1.10. While the number of patients with growth in a parathyroid gland was 7 (32%),the number of patients with multiple glands was 8 (39%). According to scintigraphy evaluation, the same values were 4 (19%) and 12(57%) patients. 7 (34%) patients were underwent adenoma excision, 11 (52%) patients were underwent subtotal parathyroidectomyand 3 (14%) patients were underwent total parathyroidectomy + parathyroid auto-implantation. Persistent hyperparathyroidism wasseen in 2 patients who underwent subtotal parathyroidectomy and 1 patient who underwent adenoma excision.Conclusion: Today, the treatment of sHPT is still the best treatment option, and as a treatment, subtotal parathyroidectomy and totalparathyroidectomy + parathyroid autoimplantation surgery should be preferred.

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1. Malluche HH, Monier-Faugere MC. Risk of adynamic bone disease in dialyzed patients. Kidney Int Suppl 1992;38:62-7.
2. Hacıyanlı M, Atahan K. Sekonder hiperparatiroidide cerrahi tedavi. Endokrinolojide Diyalog 2010;7:156-61.
3. Toçoğlu GA, Sipahi S, Tamer A. Sekonder hiperparatiroidi nedeniyle opere olan hastalar ile medikal tedavi alan hastalar arasindaki maliyet analizi. Turk Neph Dial Transpl 2015;24:82-7.
4. Sancho JJ, Sitges-Serra A. Metabolic complications of secondary hyperparathyroidism. In: Clark OH, Duh QY, Kebebew E, eds. Textbook of Endocrine Surgery, Philadelphia, Elsevier Inc; 2005. p. 502-9.
5. Liang Y, Sun Y, Ren L, et al. Short-term efficacy of surgical treatment of secondary hyperparathyroidism. Eur Rev Med Pharmacol Sci 2015;19:3904-9.
6. Uhlig K, Berns JS, Kestenbaum B,et al. KDOQI US commentary on the 2009 KDIGO Clinical Practice Guideline forthe Diagnosis, Evaluation, and Treatment of CKDMineral and Bone Disorder (CKD-MBD). Am J Kidney Dis 2010;55:773-99.
7. Dumasius V, Angelos P. Parathyroid surgery in renal failure patients. Otolaryngol Clin North Am 2010;43:433-40.
8. Ekici Y, Pehlivan S, Karakayalı FY, ve ark. Sekonder hiperparatiroidizm tedavisinde subtotal paratiroidektominin etkinliği: Bir merkezin sonuçları. Ulusal Cerrahi Dergisi 2007;23:41-5.
9. Ballinger AE, Palmer SC, Nistor I, Craig JC, Strippoli GF. Calcimimetics for secondary hyperparathyroidism in chronic kidney disease patients. Cochrane Database Syst Rev 2014;24:CD006254.
10. Uludağ M. Kronik Böbrek Hastalıklı Hastalarda Sekonder Hiperparatiroidizm: Tanı, Medikal ve Cerrahi Tedavi. Şişli Etfal Hastanesi Tıp Bülteni 2016;50:256-72.
11. Pitt SC, Sippel RS, Chen H. Secondary and tertiary hyperparathyroidism, state of the art surgical management. Surg Clin North Am 2009;89:1227-39.
12. Madorin C, Owen RP, Fraser WD, et al. The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol 2012;269:1565-76.
13. Xu D, Yin Y, Hou L, et al. Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery. J Endocrinol Invest 2016;39:509-14.
14. Fukuda N, Tanaka H, Tominaga Y, et al. Decreased 1,25- dihydroxyvitamin D3 receptor density is as¬sociated with a more severe form of parathyroid hyperplasia in chronic uremic patients. J Clin Invest 1993;92:1436-43.
15. Gogusev J, Duchambon P, Hory B,et al. De¬pressed expression of calcium receptor in para-thyroid gland tissue of patients with hyperpar-athyroidism. Kidney Int 1997;51:328–36.
16. Hung GU, Wang SJ, Lin WY. Tc-99m MIBI par¬athyroid scintigraphy and intact parathyroid hor¬mone levels in hyperparathyroidism. Clin Nucl Med 2003;28:180-5.
17. Shih ML, Duh QY, Hsieh CB, et al. Total parathyroidectomy without autotransplantation for secondary hyperparathyroidism. World J Surg 2009;33:248-54.
18. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42:1–202.
19. Rothmund M, Wagner PK, Schark C. Subtotal parathyroidectomy versus total parathyroidec¬tomy and autotransplantation in secondary hy¬perparathyroidism: a randomized trial. World J Surg 1991;15:745-50.
20. Tominaga Y, Numano M, Tanaka Y, et al. Surgical treatment of renal hyperpar¬athyroidism. Semin Surg Oncol 1997;13:87- 96.
21. Nicholson ML, Veitch PS, Feehally J. Parathy¬roidectomy in chronic renal failure: a compari¬son of three operative strategies. J R Coll Surg Edinb 1996;41:382-7.
22. Lorenz K, Bartsch DK, Sancho JJ, et al. Surgical management of secondary hyperparathyroidism in chronic kidney disease--a consensus report of the European Society of Endocrine Surgeons. Langenbecks Arch Surg 2015;400:907- 27.
23. Morrone LF, Russo D, Di Iorio B. Diagnostic Workup for Disorders of Bone and Mineral Metabolism in Patients with Chronic Kidney Disease in the Era of KDIGO Guidelines. Int J Nephrol 2011;2011:958798.