Secondary hyperparatiroidism

86 patients (pts) with secondary hyperparathyroidism (HPT), (45 F-53% and 41M-47%), of ages ranging between 26 and 76 years, have been operated on for parathyroidectomy (PTX) between 1974 and 1995. The clinical and radiological signs of osteodystrophy was present in 100% of the patients, pathological fractures in 23%, ectopical calcification in 25%. Serum calcium was elevated in 75%, alkaline phosphatase and PTH (determined by routine from 1980) in 100%. In 3 pts. (3,5%) PTX was performed after kidney transplantation, in 11 pts (13%) kidney transplantation was performed after PTX. At operation were found only one gland in 3 pts (3,5%), two glands in 3 pts (3,5%), three glands in 9 pts (10%), four glands in 66 pts (77%) and more than four glands in 5 pts (6%). 44 (51%) PTX , 24 (28%) PTXA and 3 (4%) PTXT have been performed. In the pts in which less than 4 glands have been found, 9 (10%) “Total” exeresis have been performed and 6 (7%) Sub-Total. The hystological feature, except 3 pts with only one gland, was asymmetrical hyperplasia in 30 pts (36%) and symmetrical nodular hyperplasia in 53 pts (64%). At the follow-up it was observed: −3 pts with persistent HPT (3,5%), −20 pts with recurrence of HPT (23%), −2 with HypoPT (2,5%), −2 with serious osteomalacia (from Aluminium) without signs of recurrence, -after PTX 10 recurrences (22%) and 1 HypoPT (2%), -after PTXA 7 recurrences (29%) and no HypoPT, -after PTXT no recurrence and 1 (33%) HypoPT. In the 3 pts in which only one gland was found, 3 persistent HPT (100%) were registered; in the 3 pts with 2 glands no persistent HPT or recurrence; in 9 pts with 3 glands 3 recurrences (33%) and 1 HypoPT (11%); in pts with 4 or more glands 17 recurrences of HPT (25%) and 1 HypoPT (1,5%). Finally, in 53 pts with symmetric nodular hyperplasia 17 recurrences of HPT (32%) and in the 30 pts with asymmetric hyperplasia 3 recurrences of HPT (10%). The Authors concluded that: 1) the surgery is indicated when the medical therapy is no longer able to prevent or cure the alterations correlated to the HPT, after having excluded aluminium osteopathy; 2) surgical exploration must be meticulous and must outline all the glands: a transcervical thymectomy will conclude the operation; 3) the PTX and PTXA, the preferred operations, provide the same results; the recurrence seem to be in relation not to the operation technique (22% vs 29%) but rather to the quality of the tissue, residue or implanted; 4) the PTXT with cryopreserved tissue can be helpful in pts with symmetrical nodular hyperplasia without possibility of a kidney transplantation to reduce the recurrences; 5) the kidney transplantation stabilizes the PTX results, causes a regression of the light recurrences of the HPT and improves the alterations correlated to the IRC that PTX is unable to control.