Prospektiver, randomisiert kontrollierter Vergleich der totalen Parathyreoidektomie ohne Autotransplantation mit der subtotalen Parathyreoidektomie beim renalen Hyperparathyreoidismus
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In patients with chronic renal failure, refractory renal hyperparathyroidism (rHPT) is a common problem requiring surgical parathyroidectomy (PTX). Due to lower recurrence rates total PTX without autotransplantation (totPTX) has been discussed as an alternative to subtotal PTX (subPTX) and total PTX with autotransplantation. We performed a prospective, randomized trial to compare totPTX with subPTX hypothesizing better clinical outcome after totPTX. We performed totPTX on 22 patients (median age 50,5 years; range 33 - 67 years) and subPTX on 21 patients (median age 50 years; range 28 - 75 years) suffering from rHPT. We compared the procedures on account of removed parathyroid glands, post operative course of parathyroid hormone (PTH), serum calcium (Ca2+) and other biochemical markers of calcium hemostasis including bone mineral density and coronary calcification using Agatston Score as well as the amount vitamin D medication used and the amount of deaths and medical complications occurred in our population. We followed up for 11 - 62 months (median 36 months). PTH in the group of totPTX was significantly lower (p = 0,03 intraoperatively and after check up after 11 - 47 months (median 24 months)). Also the rate of persistent or recurrent rHPT was lower after totPTX. Hypocalcemia occurred more frequently in long-term (p = 0,004) after totPTX. There was a significant increase in mean bone mineral density, a decrease of bone pain in both groups. The rate of severe coronary calcification (Agatston Score > 400) was above 50 % throughout the population. The use of calcitriol was significantly higher (p = 0,03) after totPTX only shortly after PTX. Use of calcitriol and cholecalciferol was equal in long-term follow-up. 5-year-survival was above 60 % for both procedures. Our hypothesis could not be accepted, but we conclude that totPTX and subPTX are both save and efficient procedures to normalize Ca2+ hemostasis and treat rHPT.
Subject HeadingsHyperparathyreoidismus [GND]
Parathyroid glands [MeSH]