World Journal of Endocrine Surgery

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VOLUME 2 , ISSUE 3 ( September-December, 2010 ) > List of Articles

REVIEW ARTICLE

Surgical and Medical Management of Tertiary Hyperparathyroidism

Yoshihiro Tominaga

Citation Information : Tominaga Y. Surgical and Medical Management of Tertiary Hyperparathyroidism. World J Endoc Surg 2010; 2 (3):105-109.

DOI: 10.5005/jp-journals-10002-1033

Published Online: 01-12-2010

Copyright Statement:  Copyright © 2010; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Persistent hyperparathyroidism (HPT) after successful kidney transplantation (RTx) (tertiary HPT; THPT) is a common complication in patients with RTx and may affect bone disease, deterioration of graft function and cardiovascular events. Parathyroidectomy (PTx) is the most successful treatment for resolving advanced HPT in patients with THPT. However, the surgical indications for THPT and timing of the operation are problematic because hypercalcemia can be resolved spontaneously. Subtotal and total PTx with autotransplantaion are widely accepted for THPT. The evidence to know which procedure is more appropriated could not be found. Recently the deterioration of kidney graft function after PTx for THPT has been reported and hypoparathyroidism after PTx may be avoided. Recently cinacalcet has been applied for patients with THPT and the medicine can dramaticaly control HPT and hypercalcemia. Possible risks of cinacalcet are hypocalcemia and increased calciuria and the approval for THPT remains highly controversial. A large number of prospective controlled clinical trial should be required.


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  1. Secondary and tertiary hyperparathyroidism. Endocrine Surgery McGraw-Hill manual McGraw medical (New York) 2010;10:149-61.
  2. Secondary hyperparathyroidism. Current controversy in parathyroid operation and reoperation RG. Landers company medical intelligence unit (Auston OSA) 1994;9:167-200.
  3. Surgical and Medical treatment of secondary hyperparathyroidism in patients on continuous dialysis. World J Surg 2009;33:2335-42.
  4. Lithium therapy and hyperparathyroidism: An evidence-based assessment. World J Surg 2009;33:2314-23.
  5. Case records of the Massachusetts general hospital: Case 46-1963. N Engl J Med 1963;269:97-101.
  6. Secondary and tertiary hyperparathyroidism, state of the art surgical management. Surg Clin N Am 2009;89:1227-39.
  7. Therapeutic management of post-kidney transplant hyperparathyroidism. Clin transplant 2010;1-16.
  8. Kidney Int 2006;70:363-70.
  9. Postrenal transplantation hypophosphatemia: A review and novel insights. Curr Opin Nephrol Hypertens 2006;15:97-104.
  10. Clin J Am Soc Nephrol 2008;3:1829-36.
  11. Bone disease after renal transplantation. Nat. rev. nephrol 2010;6:32-40.
  12. Kidner Int (76) Suppl 2009;113:1-140.
  13. Effects of vitamin D supplementation on the calcium-phosphate balance in renal transplant patients. Kidney Int 2009;75:646-51.
  14. Efficacy of low doses of pamidronate in osteopenic patients administered in the early postrenal transplant. Osteoporos Int 2010.
  15. Effect of pamidronate on bone loss after kidney transplantation: A randomized trial. Am J Kidney Dis 2009;53:856-65.
  16. Nephrol Dial Transplant 2002;17:204-07.
  17. Cinacalcet hydrochloride reduces the serum calcium concentration in inoperable parathyroid carcinoma. J Clin Endocrinol Metab 2007;92:3803-08.
  18. Effect of the calcimimetic cinacalcet HCl on cardiovascular disease, fracture, and healty-related quality of life in secondary hyperparathyroidism. Kidney Int 2005;68:1793-1800.
  19. Cinacalcet for the treatment of primary hyperparathyroidism. Am J Therapeutics 2010.
  20. Treatment with cinacalcet in 29 kidney transplant patients with persistent hyperparathyroidism. Transplant Proc 2009;41:2394-95.
  21. Treatment with cinacalcet of secondary hyperparathyroidism after renal transplantation. Transplant Proc 2009;41:2139-43.
  22. Treatment of persistent hyperparathyroidism in renal transplant patients with cinacalcet improves control of blood pressure. Transplant Proc 2009;41:2385-87.
  23. Calcimimetics and bone mineral density in renal transplant patients with persistent secondary hyperparathyroidism. Transplant Proc 2009;41:2144-47.
  24. Evolution of secondary hyperparathyroidism after kidney transplantation in patients receiving cinacalcet on dialysis. Transplant Proc 2009;41:2396-98.
  25. Treatment with calcimimetics in kidney transplantation. Transplantation Reviews 2010;24:79-88.
  26. Hypercalcemia secondary to persistent hyperparathyroidism in kidney transplant patients: Analysis after a year with cinacalcet. J Nephrol 2010.
  27. Cinacalcet HCl treatment in patients with chronic kidney disease stage 3 to 4. Clinical Medicine: Therapeutics 2009;1:1-2.
  28. Involution of the parathyroid glands after renal transplantation. Curr Opin Nephrol Hypertens 2003;12:363-71.
  29. Surgical treatment of persistent hyperparathyroidism after renal transplantation. Ann Surg 2008;248:18-30.
  30. Risk factors of postrenal transplant hyperparathyroidism. Saudi J Kidney Dis Transpl 2009;20(4):573-76.
  31. Surgical treatment of tertiary hyperparathyroidism: The choice of procedure matters. World J Surg.
  32. Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant recipients: A single centre study. Nephrol Dial Transplant 2005;20:1714-20.
  33. Nephron Clin Pract 2009;111:102-09.
  34. Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients. World J Surg 2010;34:1312-17.
  35. Incidence of parathyroid glands located in thymus in patients with renal hyperparathyroidism. World J Surg 2008;32:2516-19.
  36. Secondary and tertiary hyperparathyroidism: The utility of iopth monitoring. World J Surg 2010;34:1343-49.
  37. Transplantation of parathyroid glands in men: Clinical indications and results. Surgery 1975;78:34-44.
  38. Surgical indications and procedures of parathyroidectomy in patients with chronic kidney disease. Ther Apher Dial 2005;9:44-47.
  39. Graft-dependent renal hyperparathyroidism despite successful kidney transplantation. World J Surg 2008;32:557-65.
  40. Seminar Surg Oncol 1997;13:125-33.
  41. Surgical treatment of secondary hyperparathyroidism due to chronic kidney disease. Upsala J Med Sci 2006;111(3):277-92.
  42. Parathyroidectomy followed by kidney transplantation can improve bone mineral density in patients with secondary hyperparathyroidism. Transplantation 2008;86:554-57.
  43. Bone metabolism according to chronic kidney disease stages in patients undergoing kidney transplantation: A 5-year database analysis. Transplant Proc 2009;41:2403-05.
  44. Evolution of bone disease at 2 years after transplantation: A single-center study. Transplant Proc 2009;41:3063-66.
  45. Progression of coronary artery calcification in renal transplantation and the role of secondary hyperparathyroidism and inflammation. Clin J Am Soc Nephrol 2009;4:685-90.
  46. Survival following parathyroidectomy among United States dialysis patients. Kidney Int 2004;66:2010-16.
  47. Thyroid lesions in patients with renal hyperparathyroidism. Thyroidl Clin Exp 1998;10:275-77.
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