July - September 2017, Volume 13, Issue 3

Amza AB, Muntean V, Dindelegan G, Ciuce C, Georgescu CE

Surgery Outcomes in Patients with Secondary Hyperparathyroidism and Impact of Intra-Operative PTH Measurement

Acta Endo (Buc) 2017, 13 (3): 322-328
doi: 10.4183/aeb.2017.322

Context. The current therapeutical management of secondary hyperparathyroidism (S-HPTH) is difficult to obtain due to the lack of kidney donors. Surgical intervention on the pathologic parathyroid tissue has been suggested as a method to alleviate symptoms in patients with chronic kidney disease (CKD). Objective. The aim of our study was to evaluate the outcomes of parathyroid surgery in patients with S-HPTH and the advantages of intraoperative quick PTH (iqPTH) to improve surgical results. Material and methods. In a real-life study, we compared one group of S-HPTH with iqPTH performed after removing all suspected glands and before wound suture (Group 1) and one group in that iqPTH was not assessed (Group 2). When iqPTH dropped less than 50%, additional exploration followed. Results. Eight out of the 34 patients from Group 1, who underwent subtotal parathyroidectomy, showed elevated levels of serum PTH and calcium, which remained elevated during follow-up, thus, suggesting disease persistence. From the 21 patients in Group 2, none showed early postoperative disease persistence. Serum calcium, but not PTH was increased in one patient from the iqPTH group but normalized after one month. Overall, iqPTH allowed detection of a supplementary parathyroid gland in one case, thereby increasing early post-surgery remission to 100% in Group 2 compared to 76.47% in Group 1. Late postoperative remission of hyperparathyroidism with no further increase in the rate of hypoparathyroidism was obtained in Group 2. Conclusions. Assessment of intra-operative PTH levels proved to be a useful tool in augmenting the outcome of S-HPTH surgery. In patients which are eligible for renal transplantation who undergo a subtotal resection, iqPTH can enhance the post-operative quality of life by lowering disease recurrence rates until the kidney transplant procedure.

Keywords: secondary hyperparathyroidism, quick intra-operative PTH, total parathyroidectomy, surgery, chronic kidney disease, persistent S-HPTH

Correspondence: Carmen Emanuela Georgescu MD, PhD, “Iuliu Hatieganu” University of Medicine and Pharmacy, Department of Endocrinology, Cluj-Napoca, Romania, E-mail: c_e_georgescu@yahoo.com; cgeorgescu@umfcluj.ro