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Abstract: PO0360

Indications and Justification for Parathyroidectomy in Secondary Hyperparathyroidism

Session Information

Category: Trainee Case Report

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Srinivasan, Aswin, University of Houston System, Houston, Texas, United States
  • Mutnuri, Sangeeta, Creighton University, Omaha, Nebraska, United States
  • Safri, Shabbir, Montefiore Medical Center, Bronx, New York, United States
  • Agraharkar, Mahendra L., University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Introduction

Hyperparathyroidism (HPT) is a common complication of CKD, which is treated by diet, medications and surgery. Parathyroidectomy (PTectomy) is reserved for patients with refractory HPT. There are no guidelines for the timing or type of surgery. We describe five patients with HPT, who were treated with different modalities with unsatisfactory outcomes.

Case Description

We present 5 patients in a table format. Patient 1 had total PTectomy that resulted in serious hypocalcemia needing hospitalizations. After 3 years, she remains hypocalcemic requiring high doses of Vit D and calcium. Selecting a suitable phosphate binder in this patient was difficult due to hypocalcemia. Patient 2 underwent total PTectomy with autotransplantation which resulted in low calcium levels that resolved over time, but PTH levels remained very low. Patients 3 and 4 refused surgery and their PTH levels fluctuated significantly, falling to levels much below the acceptable level of 600 pg/ml. Patient 5 underwent partial PTectomy and 2 enlarged PT glands were removed. This resulted in lower calcium and higher PTH levels than prior to surgery.

Discussion

The medical management for HPT in all five patients failed. We opted for surgery when the PTH levels were in a range of 1300 to 4000 pg/ml. The surgeon decided the type of surgery. In patient 1, intraoperative PTH was measured that resulted in removal of only three glands. But within a very short time, the PTH bounced back to 2500 pg/ml which was much higher than presurgery level, and total parathyroidectomy was performed. We cannnot recommend specific surgical modality based on this experience. Therefore, we strongly feel that there is a need for larger controlled studies to elucidate specific guidelines for treating refractory HPT.

Patient Demographics
PatientsAge/SexPTectomy: P=Partial, T=Total, T+A=Total + AutotransplantationCa, PO4 and PTH
149-yr maleP then T↓Ca, ↑PO4, ↓PTH
249-yr femaleT+AN Ca, N PO4, ↓PTH
359-yr maleNoFluctuating
459-yr maleNoFluctuating
556-yr maleP↓Ca, ↑PTH, ↑PO4,