Secondary hyperparathyroidism is associated with impaired calcium, phosphorus and vitamin D balance in patients with chronic renal insufficiency, and patients are often treated medically. However, some patients have medical treatment resistance. The definition of resistant renal hyperparathyroidism despite intake of calcimimetic, parathormon binding and vitamin D analogs persistent parathormone elevation and related symptoms. The only treatment for resistant renal hyperparathyroidism is surgery. This study was designed to investigate the indications for operation of patients with parathyroidectomy due to resistant renal hyperparathyroidism.
Nineteen patients over 18 years of age who underwent hemodialysis due to end stage renal failure and who underwent parathyroidectomy due to secondary and tertiary hyperparathyroidism were included in the study. Patients pre- and post-operative and most recent calcium, phosphorus, parathormon values, operative patterns, pathology reports were recorded. Clinical results of parathyroidectomy were discussed.
The study was designed with 19 patients. Eleven of the patients were female (57.9%), 8 were male (42.1%) and the mean age was 44 ± 19 (18-91) years. Preoperative parathormon: 1811 ± 901 (436-3513) pg/ml, 3 patients (15.8%) tertiary hyperparathyroidism; Sixteen patients (84.2%) were diagnosed with secondary hyperparathyroidism. Subtotal parathyroidectomy in 11 patients (57.9%), and recurrent disease in 3 patients (15.8%). Minimally invasive surgery was performed in 5 patients (26.3%). Three patients had persistent hypoparathyroidism (15.8%). The most frequent operation indication was a very high parathormon value (18/19: 94.7%). Surgical success rate was 68.4%. In patients, the most common symptom was bone and muscle pain (84.2%).
In our series, the most common surgical causes for medical treatment-resistant renal hyperparathyroidism were parathormon elevated and bone-muscle pain.