Prevention and treatment of secondary hyperparathyroidism (SHPT) in patients on chronic maintenance hemodialysis and of tertiary hyperparathyroidism (THPT) in patients after kidney transplantation is a challenge for the nephrologist and for the surgeon. Indication and results of medical and surgical therapy for SHPT and THPT have remained under discussion during the last decades. This review resumes the current medical and surgical strategies for patients with SHPT and THPT.
FassbinderWBrunnerFPBryngerHEhrichJHHGeerlingsWRaineAEGRizzoniGSelwoodNHTufvesonGWingAJCombined report on regular dialysis and transplantation in Europe. XX, 1989. Nephrol Dial Transplant6(Suppl 1):4–65, 1991.
2.
MalbertiFMarcelliDConteFLimidoASpottiDLocatelliFParathyroidectomy in patients on renal replacement therapy: An epidemiologic study. J Am Soc Nephrol2001;12:1242–1248.
3.
KestenbaumBSeligerS.L.GillenD.L.WasseHYoungBSherrardD.J.WeissN.S.Stehman-BreenC.O.Parathyroidectomy rates among United States dialysis patients: 1990–1999. Kidney Int2004;65:282–288.
4.
JornaFHTobeTJHuismanRMde JongPEPlukkerJTStegemanCAEarly identification of risk factors for refractory secondary hyperparathyroidism in patients with long-term renal replacement therapy. Nephrol Dial Transplant2004; 19: 1168–1173.
5.
SlatopolskyEDelmezJAPathogenesis of secondary hyperparathyroidism. Nephrol Dial Transplant.1996; 11 (Suppl 3):13–135.
6.
DussoASThadhaniRSlatopolskyEVitamin D receptor and analogs. Semin Nephrol; 24: 1–6.
7.
BeckermanPSilverJVitamin D and the parathyroid. Am J Med Sci1999;317:363–369.
8.
TokumotoMTsuruyaKFukudaKKanaiHKurokiSHirakataHIidaMParathyroid cell growth in patients with advanced secondary hyperparathyroidism: Vitamin D receptor and cyclin-dependent kinase inhibitors, p21 and p27. Nephrol Dial Transplant2003;18:iii9–12.
9.
NygrenPLarssonRJohanssonHLjunghallSRastadJAkerstromG1,25(OH)2D3 inhibits hormone secretion and proliferation but not functional dedifferentiation of cultured bovine parathyroid cells. Calcif Tiss Int1988;43:213–218.
10.
KorkorABReduced binding of [3H]1,25-dihydroxyvitamin D3 in the parathyroid glands of patients with renal failure. NEngl J Med1987;316:1573–1577.
11.
JonesGStrugnellSADeLucaHFCurrent understanding of the molecular actions of vitamin D. Physiol Rev1998;78:1193–1231.
12.
PearceSHClinical disorders of extracellular calcium-sensing and the molecular biology of the calcium-sensing receptor. Ann Med2002;34:201–206.
13.
Martin-SalvagoMVillar-RodriguezJLPalma-AlvarezABeato-MorenoAGalera-DavidsonHDecreased expression of calcium receptor in parathyroid tissue in patients with hyperparathyroidism secondary to chronic renal failure. Endocr Pathol2003;14:61–1470.
14.
ChenRAGoodmanWGRole of the calcium-sensing receptor in parathyroid gland physiology. Am J Physiol Renal Physiol2004;286:F1005–1011.
15.
MalbertiFFarinaMImbasciatiEThe PTH-calcium curve and the set point of calcium in primary and secondary hyperparathyroidism. Nephrol Dial Transplant.1999; 14: 2398–2406.
16.
MiyamotoKItoMSegawaHKuwahataMSecondary hyperparathyroidism and phosphate sensing in parathyroid glands. J Med Invest2000;47:118–122.
17.
SlatopolskyEFinchJDendaMRitterCZhongMDussoAMacDonaldPNBrownAJPhosphorus restriction prevents parathyroid gland growth. High phosphorus directly stimulates PTH secretion in vitro. J Clin Invest1996; 97: 2534–2540.
18.
MalmaeusJGrimeliusLJohanssonHAkerstromGLjunghallSParathyroid pathology in hyperparathyroidism secondary to chronic renal failure. Scand J Urol Nephrol1984;18:157–166.
19.
YongJLVrgaLWarrenBAA study of parathyroid hyperplasia in chronic renal failure. Pathology1994;26:99–109.
20.
BlockGAPortFKRe-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: Recommendations for a change in management. Am J Kidney Dis2000;35:1226–1237.
21.
GoodmanWG. The consequences of uncontrolled secondary hyperparathyroidism and its treatment in chronic kidney disease. Semin Dial2004; 17: 209–216.
22.
ChouFFLeeCHChenJBGeneral weakness as an indication for parathyroid surgery in patients with secondary hyperparathyroidism. Arch Surg1999;134:1108–1111.
23.
ChouFFCheeECLeeCHSheen-ChenSMMuscle force, motor nerve conduction velocity and compound muscle action potentials after parathyroidectomy for secondary hyperparathyroidism. Acta Neurol Scand2002;106:218–221.
24.
MassrySGPopovtzerMMCoburnJWMakoffDLMaxwellMHKleemanCRIntractable pruritus as a manifestation of secondary hyperparathyroidism in uremia. Disappearance of itching after subtotal parathyroidectomy. N Engl J Med1968; 279: 697–700.
25.
ChouFFHoJCHuangSCSheen-ChenSMA study on pruritus after parathyroidectomy for secondary hyperparathyroidism. J Am Coll Surg2000;190:65–70.
26.
CovicAFloreaLUngureanuCCovicMRenal osteodystrophy (II). Rev Med Chir Soc Med Nat Iasi2000;104:21–25.
27.
PrzedlackiJTrebickaJBijakKMatuszkiewicz-RowinskaJBogdanska-StraszynskaBMaleckaGOstrowskiKCross-linked C-terminal telopeptide of type I collagen in serum before and after treatment with alfacalcidol and calcium carbonate in early and moderate chronic renal failure. Nephron2002; 92:304–308.
28.
PohlmeierRVienkenJPhosphate removal and hemodialysis conditions. Kidney Int Suppl2001; 78: 190–194.
29.
IndridasonOSQuarlesLDHyperphosphatemia in end-stage renal disease. Adv Ren Replace Ther2002;9:184–192.
30.
ChertowGMBurkeSKDillonMALong-term effects of sevelamer hydrochloride on the calcium x phosphate product and lipid profile of haemodialysis patients. Nephrol Dial Transplant1999;14:2907–2914.
31.
ChertowGMBurkeSKRaggiPSevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int2002;62:245–252.
32.
HutchisonAJCalcitriol, lanthanum carbonate, and other new phosphate binders in the management of renal osteodystrophy. Perit Dial Int1999;19:408–412.
33.
SlatopolskyEDussoABrownANew analogs of vitamin D3. Kidney Int Suppl1999;73:46–51.
34.
SpragueSMLermaEMcCormmickDSuppression of parathyroid hormone secretion in hemodialysis patients: Comparison of paricalcitol with calcitriol. Am J Kidney Dis2001;38:51–56.
35.
MartinKJGonzálezEAGellensM19-nor-1-a-25-dihydroxyvitamin D2 (Paricalcitol) safely and effectively reduces the levels of intact PTH in patients on hemodialysis. J Am Soc Nephrol1998;9:1427–1432.
36.
CoburnJWMaungHMElangovanLGermainMJLindbergJSSpragueSMWilliamsMEBishopCWDoxercalciferol safely suppresses PTH levels in patients with secondary hyperparathyroidism associated with chronic kidney disease stages 3 and 4. Am J Kidney Dis2004;43:877–890.
37.
FrazaoJMElangovanLMaungHMIntermittent doxercalciferol (1α-hydroxyvitamin D(2)) therapy for secondary hyperparathyroidism. Am J Kidney Dis2000;36:550–561.
38.
MaungHMElangovanLFrazaoJMEfficacy and side effects of intermittent intravenous and oral doxercalciferol (1α-hydroxyvitamin D(2)) in dialysis patients with secondary hyperparathyroidism: A sequential comparison. Am J Kidney Dis2001;37:532–543.
39.
AkizawaTSuzukiMAkibaTLong-term effect of 1,25-dihydroxy-22-oxavitamin D(3) on secondary hyperparathyroidism in haemodialysis patients. One-year administration study. Nephrol Dial Transplant2002; 17: 28–36.
40.
AkibaTMarumoFOwadaAControlled trial of falecalcitriol versus alfacalcidol in suppression of parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis1998;32:238–246.
41.
TengMWolfMLowrieESurvival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med2003;349:446–456.
42.
StanburySWLumbGANicholsonWFElective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet1960;1:793–799.
43.
OggCSTotal parathyroidectomy in treatment of secondary (renal) hyperparathyroidism. Br Med J1967;4:331–334.
44.
GeisWPPopovtzerMMCormanJLHalgrimsonCGGrothCGStarziTEThe diagnosis and treatment of hyperparathyroidism after renal homotransplantation. Surg Gynecol Obstet1973; 137: 997–1010.
45.
WellsSAJrGunnellsJCShelburneJDSchneiderABSherwoodLMTransplantation of the parathyroid glands in man: Clinical indications and results. Surgery1975;78:34–14.
46.
OckertSWillekeFRichterAJonescheitJSchnuellePvan der WoudeFPostSTotal parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism. Langenbecks Arch Surg2002;387:204–209.
47.
HamplHSteinmullerTFrohlingPNaoumCLederKStabellUSchnoyNJehlePMLong-term results of total parathyroidectomy without autotransplantation in patients with and without renal failure. Miner Electrolyte Metab1999;25:161–170.
48.
NicholsonMLVeitchPSFeehallyJParathyroidectomy in chronic renal failure: Comparison of three operative strategies. J R Coll Surg Edinb1996;41:382–387.
49.
StrackeSJehlePMSturmDSchoenbergMHWidmaierUBegerHGKellerFClinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure. Am J Kidney Dis1999;33:304–311.
50.
RothmundMWagnerPKReoperations for persistent and recurrent secondary hyperparathyroidism. Ann Surg1988;207:310–314.
51.
DruekeTBZingraffJThe dilemma of parathyroidectomy in chronic renal failure. Curr Opin Nephrol Hypertens1994;3:386–395.
52.
RothmundMWagnerPKScharkCSubtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: A randomized trial. World J Surg1991;15:745–750.
53.
HamplHSteinmullerTStabellUKlingenbergHJSchnoyNNeuhausPRecurrent hyperparathyroidism after total parathyroidectomy and autotransplantation in patients with long-term hemodialysis. Miner Electrolyte Metab1991;17:256–260.
54.
WalgenbachSHommelGJungingerTProspective evaluation of parathyroid graft function after total parathyroidectomy and heterotopic autotransplantation in renal hyperparathyroidism by bi-lateral determination of intact parathormone in cubital venous blood. World J Surg1998; 22: 93–97.
55.
LjuticDCameronJSOggCSTurnerCHicksJAOwenWJLong-term follow-up after total parathyroidectomy without parathyroid reimplantation in chronic renal failure. QJM1994;87:685–92.
56.
SkinnerKAZuckerbraunLRecurrent secondary hyperparathyroidism. An argument for total parathyroidectomy. Arch Surg1996; 131: 724–727.
57.
CaccitoloJAFarleyDRvan HeerdenJAGrantCSThompsonGBSterioffSThe current role of parathyroid cryopreservation and autotransplantation in parathyroid surgery: An institutional experience. Surgery1997;122:1062–1067.
RothmundMWagnerPKAssessment of parathyroid graft function after autotransplantation of fresh and cryopreserved tissue. World J Surg.1984; 8: 527–533.
61.
SchlosserKSitterHRothmundMZielkeAAssessing the site of recurrence in patients with secondary hyperparathyroidism by a simplified Casanova autograftectomy test. World J Surg2004;28:583–588.
62.
Stehman-BreenCMuirheadNThorningDSherrardDSecondary hyperparathyroidism complicated by parathyromatosis. Am J Kidney Dis1996;28:502–507.
63.
KollmorgenCFAustMRFerreiroJAMcCarthyJTvan HeerdenJAParathyromatosis: A rare yet important cause of persistent or recurrent hyperparathyroidism. Surgery1994;116:111–115.
64.
DotzenrathCCupistiKGoretzkiEMondryAVossoughAGrabenseeBRoherHDOperative treatment of renal autonomous hyperparathyroidism: Cause of persistent or recurrent disease in 304 patients. Langenbecks Arch Surg2003;387:348–354.
65.
TominagaYUchidaKHabaTKatayamaASatoTHibiYNumanoMTanakaYInagakiHWatanabeIHachisukaTTakagiHMore than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism. Am J Kidney Dis2001;38:168–171.
66.
CasanovaDSarfatiEde FranciscoAAmadoJAAriasMDubostCSecondary hyperparathyroidism: Diagnosis of site of recurrence. World J Surg1991;15:546–549.
67.
KnudsenLBrandiLDaugaardHOlgaardKLockwoodKFive to 10 years follow-up after total parathyroidectomy and autotransplantation of parathyroid tissue: Evaluation of parathyroid function by use of ischaemic blockade manoeuvre. Scand J Clin Lab Invest1996;56:47–51.
68.
DiethelmAGEdwardsRPWhechelJDThe natural history and surgical treatment of hypercalcaemia before and after renal transplantation. Surg Gynecol Obstet1982;154:481–490.
69.
DotzenrathCGoretzkiPERöherHDOperative therapy of secondary hyperparathyroidism after renal transplantation. Langenbecks Arch Chir1993; 378:121–124.
70.
DavidDSSakaiS: Hypercalcaemia after renal transplantation. Engl J Med1973; 289: 398.
71.
D'AlessandroAMMelzerJS: Tertiary hyperparathyroidism after renal transplantation: Operative indications. Surgery1989;106:1049–1056.
72.
KerbyJDRueLWBlairHHudsonSSellersMTDiethelmAGOperative treatment of tertiary hyperparathyroidism: A single-center experience. Ann Surg1998;227:878–886.
73.
AlfreyACJenkinsDGrothCGResolution of hyperparathyreoidism, renal osteodystrophy and metastatic calcification after renal homotransplantation. N Engl J Med1968;279:1349.
74.
JohnsonJWHattnerRSHampersCL: Secondary hyperparathyreoidism in chronic renal failure. JAMA1971;215:478.
75.
WilsonREHampersCL: Subtotal parathyreoidectomy in chronic renal failure. A seven year experience in a dialysis and transplant program. Ann Surg1971; 174: 640–652.
76.
Sitges-SerraAGoresP: Serum calcium as an early indicator for surgical treatment after renal transplantation. World J Surg1986;10:661.
77.
Sitges-SerraAEstellerE: Indications and late results of subtotal parathyroidectomy for hyperparathyroidism after renal transplantation. World J Surg1984;8:534–539.
