Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience
Introduction. Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hype...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-01-01
|
| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2018/6065720 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832548398476034048 |
|---|---|
| author | Claudio Casella Alessandro Galani Luigi Totaro Silvia Ministrini Silvia Lai Mira Dimko Nazario Portolani |
| author_facet | Claudio Casella Alessandro Galani Luigi Totaro Silvia Ministrini Silvia Lai Mira Dimko Nazario Portolani |
| author_sort | Claudio Casella |
| collection | DOAJ |
| description | Introduction. Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hypercalcemia. The aim of this study is to compare the efficacy and safety of total parathyroidectomy with subcutaneous forearm autotransplantation with total parathyroidectomy with intramuscular forearm autotransplantation. Materials and Methods. A single-center retrospective cohort study of total parathyroidectomy with forearm autotransplantation from January 2002 to February 2013 was performed. According to the surgical technique, patients were divided into an intramuscular group (Group 1) and a subcutaneous group (Group 2). 38 patients with secondary hyperparathyroidism were enrolled; 23 patients were subjected to total parathyroidectomy with parathyroid tissue replanting in the subcutaneous forearm of the upper nondominant limb, while 15 patients were subjected to replanting in the intramuscular seat. Results. A total of 38 patients (56 ± 13 years) were enrolled. In both groups, the preoperative iPTH value was markedly high, 1750 ± 619 pg/ml in the intramuscular autotransplantation group and 1527 ± 451 pg/ml in the subcutaneous autotransplantation group (p=0.079). Transient hypoparathyroidism was shown in 7 patients, and 1 patient showed persistent hypoparathyroidism (p=0.387). 2 patients showed persistent hyperparathyroidism (p=0.816), and in 2 others was found recurrent hyperparathyroidism (p=0.816); 3 of them underwent autograftectomy. The anterior compartment of the forearm nondominant limb was sacrificed in 1 case of intramuscular autotransplantation with functional arm deficit. Conclusions. The efficacy and safety of parathyroid tissue autotransplantation in the subcutaneous forearm of the upper nondominant limb is confirmed with a good rate of tissue engraftment and with a comparable number of postsurgical transient and persistent hypoparathyroidism and hyperparathyroidism incidence in both techniques. Furthermore, this technique preserves arm functionality in the case of autograftectomy. Consequently, it is our opinion that total parathyroidectomy with subcutaneous forearm autotransplantation is currently the best choice. |
| format | Article |
| id | doaj-art-69908a91f70f4297873ecc7abe5cb960 |
| institution | Kabale University |
| issn | 1687-8337 1687-8345 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Endocrinology |
| spelling | doaj-art-69908a91f70f4297873ecc7abe5cb9602025-02-03T06:14:08ZengWileyInternational Journal of Endocrinology1687-83371687-83452018-01-01201810.1155/2018/60657206065720Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center ExperienceClaudio Casella0Alessandro Galani1Luigi Totaro2Silvia Ministrini3Silvia Lai4Mira Dimko5Nazario Portolani6Department of Molecular and Translational Medicine, Surgical Clinic, University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, ItalyDepartment of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, ItalyDepartment of Clinical Medicine, Sapienza University of Rome, Rome, ItalyNephrology and Dialysis Unit, ASST Carlo Poma, Mantova, ItalyDepartment of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, ItalyIntroduction. Secondary hyperparathyroidism is common in chronic kidney disease. Parathyroidectomy is indicated in refractory hyperparathyroidism when medical treatments and so the parathyroid hormone levels cannot be lowered to acceptable values without causing significant hyperphosphatemia or hypercalcemia. The aim of this study is to compare the efficacy and safety of total parathyroidectomy with subcutaneous forearm autotransplantation with total parathyroidectomy with intramuscular forearm autotransplantation. Materials and Methods. A single-center retrospective cohort study of total parathyroidectomy with forearm autotransplantation from January 2002 to February 2013 was performed. According to the surgical technique, patients were divided into an intramuscular group (Group 1) and a subcutaneous group (Group 2). 38 patients with secondary hyperparathyroidism were enrolled; 23 patients were subjected to total parathyroidectomy with parathyroid tissue replanting in the subcutaneous forearm of the upper nondominant limb, while 15 patients were subjected to replanting in the intramuscular seat. Results. A total of 38 patients (56 ± 13 years) were enrolled. In both groups, the preoperative iPTH value was markedly high, 1750 ± 619 pg/ml in the intramuscular autotransplantation group and 1527 ± 451 pg/ml in the subcutaneous autotransplantation group (p=0.079). Transient hypoparathyroidism was shown in 7 patients, and 1 patient showed persistent hypoparathyroidism (p=0.387). 2 patients showed persistent hyperparathyroidism (p=0.816), and in 2 others was found recurrent hyperparathyroidism (p=0.816); 3 of them underwent autograftectomy. The anterior compartment of the forearm nondominant limb was sacrificed in 1 case of intramuscular autotransplantation with functional arm deficit. Conclusions. The efficacy and safety of parathyroid tissue autotransplantation in the subcutaneous forearm of the upper nondominant limb is confirmed with a good rate of tissue engraftment and with a comparable number of postsurgical transient and persistent hypoparathyroidism and hyperparathyroidism incidence in both techniques. Furthermore, this technique preserves arm functionality in the case of autograftectomy. Consequently, it is our opinion that total parathyroidectomy with subcutaneous forearm autotransplantation is currently the best choice.http://dx.doi.org/10.1155/2018/6065720 |
| spellingShingle | Claudio Casella Alessandro Galani Luigi Totaro Silvia Ministrini Silvia Lai Mira Dimko Nazario Portolani Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience International Journal of Endocrinology |
| title | Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience |
| title_full | Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience |
| title_fullStr | Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience |
| title_full_unstemmed | Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience |
| title_short | Total Parathyroidectomy with Subcutaneous Parathyroid Forearm Autotransplantation in the Treatment of Secondary Hyperparathyroidism: A Single-Center Experience |
| title_sort | total parathyroidectomy with subcutaneous parathyroid forearm autotransplantation in the treatment of secondary hyperparathyroidism a single center experience |
| url | http://dx.doi.org/10.1155/2018/6065720 |
| work_keys_str_mv | AT claudiocasella totalparathyroidectomywithsubcutaneousparathyroidforearmautotransplantationinthetreatmentofsecondaryhyperparathyroidismasinglecenterexperience AT alessandrogalani totalparathyroidectomywithsubcutaneousparathyroidforearmautotransplantationinthetreatmentofsecondaryhyperparathyroidismasinglecenterexperience AT luigitotaro totalparathyroidectomywithsubcutaneousparathyroidforearmautotransplantationinthetreatmentofsecondaryhyperparathyroidismasinglecenterexperience AT silviaministrini totalparathyroidectomywithsubcutaneousparathyroidforearmautotransplantationinthetreatmentofsecondaryhyperparathyroidismasinglecenterexperience AT silvialai totalparathyroidectomywithsubcutaneousparathyroidforearmautotransplantationinthetreatmentofsecondaryhyperparathyroidismasinglecenterexperience AT miradimko totalparathyroidectomywithsubcutaneousparathyroidforearmautotransplantationinthetreatmentofsecondaryhyperparathyroidismasinglecenterexperience AT nazarioportolani totalparathyroidectomywithsubcutaneousparathyroidforearmautotransplantationinthetreatmentofsecondaryhyperparathyroidismasinglecenterexperience |