Die totale Parathyreoidektomie ohne Autotransplantation und Thymektomie

Zusammenfassung

Der sekundäre Hyperparathyreoidismus führt zu renaler Osteodystrophie („chronic kidney disease-mineral and bone disorder” [CKDMBD]) und progredienten Gefäßverkalkungen. Indikationen für eine Parathyreoidektomie (PTX) umfassen ein Versagen der medikamentösen Therapie bestehend aus Phosphatbindern, aktivem Vitamin D und Kalzimimetika sowie eine knochenbioptisch nachgewiesene hyperparathyreoide Knochenerkrankung, sonografisch vergrößerte Epithelkörperchen, pathologische Frakturen, therapierefraktärer Juckreiz und/oder eine Kalziphylaxie. Die PTX kann als subtotale oder totale PTX mit und ohne Thymektomie und mit und ohne Autotransplantation von Nebenschilddrüsengewebe erfolgen. Wir favorisieren die totale Parathyreoidektomie ohne Autotransplantation und ohne Thymektomie. Dieses ist ein sicheres, rezidivarmes und kosteneffektives Verfahren, postoperativ einfach substituierbar und ermöglicht die adäquate Dosierung von aktivem Vitamin D.

Summary

Hyperparathyroidism secondary to chronic renal failure (sHPT) leads to renal osteodystrophy – recently renamed chronic kidney disease-mineral and bone disorder (CKD-MBD) – and to progressive extraosseous calcification, especially of blood vessels. Indications for parathyroidectomy (PTX) comprise failure of conventional therapy with phosphate binders, active vitamin D and calcimimetics as well as a bone biopsy showing hyperparathyroid bone disease, sonographically enlarged parathyroid glands, pathological fractures and/ or calciphylaxis. PTX can be performed in several variants: subtotal or total PTX with/without thymectomy and with/without autotransplantation of parathyroid tissue. We favour total parathyroidectomy without autotransplantation and without thymectomy. This is a safe, cost effective procedure with a low recurrency rate for sHPT. It is postoperatively easily manageable and allows for adequate dosage of active vitamin D.

Schlüsselwörter

Niereninsuffizienz - Parathyreoidektomie - Vitamin D

Keywords

Chronic renal failure - parathyroidectomy - vitamin D

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