BACKGROUND: Secondary hyperparathyroidism is a common complication in uremic patients. Total parathyroidectomy combined with partial autotransplantation into brachioradialis muscle has been the preference among the options for surgical treatment. This study was designed to evaluate the reserve and ability of suppression of autotransplanted parathyroid tissue using dynamics tests. METHODS: We studied, prospectively, 12 patients in recent (RP) and late (LP) postoperative of total parathyroidectomy with autotransplantation. For analysis of the secretory reserve capacity, we induced hypocalcemia by ethylenediaminetetraacetic acid (EDTA) infusion. Furthermore, for analysis of the ability for parathyroid hormone (PTH) suppression, the hypercalcemia test was used, by intravenous administration of calcium in LP. RESULTS: In RP, there was a decrease in the average serum levels of PTH, phosphorus, and alkaline phosphatase, which ranged from 13 to 231 (87 +/- 65) pg/ml, 2.3 to 6.2 (3.3 +/- 1.1) mg/dl, and 77 to 504 (250 +/- 135) U/L, respectively, similar to that observed in LP. The analysis of the average curve of variations in PTH during testing of the stimulus with EDTA showed lack of secretion in RP and partial response in LP. Impaired suppression ability of the graft in LP was observed in the test with intravenous calcium. CONCLUSIONS: Total parathyroidectomy followed by partial autotransplantation was effective in reducing PTH serum levels in patients with terminal kidney disease. The elevation of serum calcium during the suppression test was not able to inhibit the autograft gland secretion of PTH. The assessment of parathyroid graft function demonstrated an inability to respond to the stimulus of hypocalcemia induced by EDTA, although there was a partial recovery, in late postoperative period.
BACKGROUND: Secondary hyperparathyroidism is a common complication in uremic patients. Total parathyroidectomy combined with partial autotransplantation into brachioradialis muscle has been the preference among the options for surgical treatment. This study was designed to evaluate the reserve and ability of suppression of autotransplanted parathyroid tissue using dynamics tests. METHODS: We studied, prospectively, 12 patients in recent (RP) and late (LP) postoperative of total parathyroidectomy with autotransplantation. For analysis of the secretory reserve capacity, we induced hypocalcemia by ethylenediaminetetraacetic acid (EDTA) infusion. Furthermore, for analysis of the ability for parathyroid hormone (PTH) suppression, the hypercalcemia test was used, by intravenous administration of calcium in LP. RESULTS: In RP, there was a decrease in the average serum levels of PTH, phosphorus, and alkaline phosphatase, which ranged from 13 to 231 (87 +/- 65) pg/ml, 2.3 to 6.2 (3.3 +/- 1.1) mg/dl, and 77 to 504 (250 +/- 135) U/L, respectively, similar to that observed in LP. The analysis of the average curve of variations in PTH during testing of the stimulus with EDTA showed lack of secretion in RP and partial response in LP. Impaired suppression ability of the graft in LP was observed in the test with intravenous calcium. CONCLUSIONS: Total parathyroidectomy followed by partial autotransplantation was effective in reducing PTH serum levels in patients with terminal kidney disease. The elevation of serum calcium during the suppression test was not able to inhibit the autograft gland secretion of PTH. The assessment of parathyroid graft function demonstrated an inability to respond to the stimulus of hypocalcemia induced by EDTA, although there was a partial recovery, in late postoperative period.
Authors: J A Ramirez; W G Goodman; J Gornbein; C Menezes; L Moulton; G V Segre; I B Salusky Journal: J Clin Endocrinol Metab Date: 1993-06 Impact factor: 5.958
Authors: G Coen; S Calabria; G Bellinghieri; F Pecchini; F Conte; M G Chiappini; M Ferrannini; C Lagona; A Mallamace; M Manni; M DiLuca; D Sardella; F Taggi Journal: Nephron Date: 2001-06 Impact factor: 2.847
Authors: María Martín-Salvago; José L Villar-Rodríguez; Alfonso Palma-Alvarez; Antonio Beato-Moreno; Hugo Galera-Davidson Journal: Endocr Pathol Date: 2003 Impact factor: 3.943
Authors: J A Diaz-Buxo; W T Geissinger; P J Walker; J T Chandler; C D Farmer; K L Holt; P Wolfe Journal: Clin Nephrol Date: 1981-12 Impact factor: 0.975
Authors: O Kifor; F D Moore; P Wang; M Goldstein; P Vassilev; I Kifor; S C Hebert; E M Brown Journal: J Clin Endocrinol Metab Date: 1996-04 Impact factor: 5.958
Authors: Leyre Lorente-Poch; Juan Sancho; Jose Luis Muñoz; Lander Gallego-Otaegui; Carlos Martínez-Ruiz; Antonio Sitges-Serra Journal: Langenbecks Arch Surg Date: 2017-01-07 Impact factor: 3.445
Authors: Maria Luiza Diniz de Sousa Lopes; Assis Filipe Medeiros Albuquerque; Adriano Rocha Germano; Lélia Maria Guedes Queiroz; Márcia Cristina da Costa Miguel; Éricka Janine Dantas da Silveira Journal: Oral Maxillofac Surg Date: 2015-03-19