| Theme |
Evidence-based strategies for secondary hyperparathyroidism |
| Title |
Timing of parathyroidectomy for advanced renal hyperparathyroidism |
| Author |
Yoshihiro Tominaga |
Departments of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital |
| Author |
Susumu Matsuoka |
Departments of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital |
| Author |
Norihiko Goto |
Departments of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital |
| Author |
Akio Katayama |
Departments of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital |
| Author |
Tetsuhiko Sato |
Departments of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital |
| Author |
Tsuneo Ueki |
Departments of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital |
| Author |
Toshihito Haba |
Departments of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital |
| Author |
Kazuharu Uchida |
Departments of Surgery, Renal Center, Nagoya 2nd Red Cross Hospital |
| [ Summary ] |
It is not easy to decide on the timing of surgical treatments for advanced renal hyperparathyroidism (HPT), because we don't have adequate evidence to decide on surgical indications at this time. We have performed more than 1,600 parathyroidectomies (PTx) for advanced renal HPT and based on the clinical effects of PTx, the following surgical indications have been adopted. The first is that symptomatic renal HPT is an absolute surgical indication and the timing is too late. The second is that to prevent cardiovascular complications induced by ectopic calcification, PTx should be performed before the progression of vessel and valve calcification, because it is irreversible with PTx. Patients whose serum intact PTH>500 pg/ml and serum calcium levels are>10.5 mg/dl or serum phosphate levels are>6.5 mg/dl and who have at least one enlarged parathyroid gland, (ie the longest diameter exceeding 1.0 cm) or who's estimated volume by ultrasonography is over 500 mm3, require PTx. If medical treatment can not achieve optimal PTH levels, <300 pg/ml, surgical treatment can be advised for those patients to improve their long-term prognose. |