July - September 2013, Volume 9, Issue 3

Neagoe RM, Sala D.T., Roman V., Voidazan S., Pascanu I

Subtotal Parathyroidectomy in the Treatment of Renal Hyperparathyroidisim - Single Center Initial Experience

Acta Endo (Buc) 2013, 9 (3): 385-396
doi: 10.4183/aeb.2013.385

experience regarding the first 24 patients diagnosed with refractory secondary and/ or tertiary hyperparathyroidism (HPT) who underwent subtotal parathyroidectomy (sPTx) in our clinic between 2010 and 2012. Methods. Data were retrospectively retrieved from a prospectively maintained database. We included patients diagnosed with refractory secondary and/or tertiary HPT who underwent sPTx; we excluded patients who underwent total parathyroidectomy (tPTx) and patients followed-up for less than six months. Results. We analyzed 24 patients,16 women (66.7%) and 8 men (33.3%) who were evaluated in a prospective manner in a short (1-6 months)/ medium (6-18 months) term follow up. Preoperative intact parathyroid hormone level (iPTH) was characterized by a median of 2131 pg/ mL (range: 1141-10000); in the first month after surgery the median iPTH level was 28 pg/mL (range: 3-1263). We found a statistically significant difference (p<0.01: Student test) in calcium level between preoperative values and values in the first month after surgery. Postoperative serum phosphorus (nv: 2.7-4.5 mg/dL) normalized in 19 patients (79.16%) and serum alkaline phosphatase values decreased significantly in the interval 2-6 months postoperative versus preoperative levels (p-0.002). We tried to establish a correlation between preoperative alkaline phosphatase (Alk Phos) and postoperative calcium level in the first month postoperatively. The overall clinical response to sPtx was good and we did not encounter postoperative mortality in our series. Conclusion. We believe that subtotal parathyroidectomy is feasible, safe and effective for patients with refractory secondary and tertiary hyperparathyroidism.

Keywords: subtotal parathyroidectomy, renal hyperparathyroidism, short/ medium term follow-up.

Correspondence: Radu Mircea Neagoe MD, Emergency Mures County Hospital - 2nd Dept. of Surgery, 50 Gheorghe Marinescu Street, Targu Mures, 540136, Romania, E-mail: neagoerm@gmail.com