Download PDF
Osteologie 2009; 18(02): 125-127
DOI: 10.1055/s-0037-1619890
Renale Osteopathie
Schattauer GmbH

Die totale Parathyreoidektomie ohne Autotransplantation und Thymektomie

Total parathyroidectomy without autotransplantation and without thymectomy
S. Stracke
1   Nephrologie der Universitätsklinik Greifswald
,
F. Keller
2   Nephrologie der Universitätsklinik Ulm
,
D. Henne-Bruns
3   Allgemein-, Viszeral-und Transplantationschirurgie der Universitätsklinik Ulm
,
G. Steinbach
4   Klinische Chemie der Universitätsklinik Ulm
,
P. Würl
3   Allgemein-, Viszeral-und Transplantationschirurgie der Universitätsklinik Ulm
› Author Affiliations
Further Information

Publication History

eingereicht: 21 April 2009

angenommen: 29 April 2009

Publication Date:
28 December 2017 (online)

    Permissions and Reprints

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
 

  • Literatur

  • 1 Balling R, Erben RG. From parathyroid to thymus, via glial cells. Nat Med 2000; 06: 860-861.
    CrossrefPubMedGoogle Scholar
  • 2 Block GA. et al. Association of serum phosphorus and calcium phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998; 31: 607-617.
    CrossrefPubMedGoogle Scholar
  • 3 Block GA. et al. Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis N Engl J Med. 2004; 350: 1516-1525.
    PubMedGoogle Scholar
  • 4 Ding C. et al. Familial isolated hypoparathyroidism caused by a mutation in the gene for the transcription factor GCMB. J Clin Invest 2001; 108 (08) 1215-1220.
    CrossrefPubMedGoogle Scholar
  • 5 Drueke TB, Zingraff J. The dilemma of parathyroidectomy in chronic renal failure. Curr Opin Nephrol Hypertens 1994; 03: 386-395.
    CrossrefPubMedGoogle Scholar
  • 6 Farrington K. et al. How complete is a total parathyroidectomy in uraemia?. Br Med J 1987; 294: 743.
    CrossrefPubMedGoogle Scholar
  • 7 Foley RN. et al. Cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 03 (Suppl): S112-S119.
    Google Scholar
  • 8 Gagne ER. et al. Short-and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J Am Soc Nephrol 1992; 03: 1008-1017.
    Google Scholar
  • 9 Gal-Moscovici A, Popovtzer MM. Parathyroid hormone-independent osteoclastic resorptive bone disease: a new variant of adynamic bone disease in haemodialysis patients. Nephrol Dial Transplant 2002; 17: 620-624.
    CrossrefPubMedGoogle Scholar
  • 10 Ganesh SK. et al. Association of elevated serum PO4, CaxPO4 product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001; 12: 2131-2138.
    PubMedGoogle Scholar
  • 11 Giannini S. et al. Persistently increased bone turnover and low bone density in long-term survivors to kidney transplantation. Clin Nephrol 2001; 56: 353-363.
    PubMedGoogle Scholar
  • 12 Gmehlin U. et al. Ventricular fibrillation due to hypocalcemia after parathyroidectomy with autotransplantation of parathyroid tissue in a dialysis patient. Nephron 1995; 70 (01) 110-111.
    CrossrefPubMedGoogle Scholar
  • 13 Gunther T. et al. Genetic ablation of parathyroid glands reveals another source of parathyroid hormone. Nature 2000; 13 (406) 199-203.
    Google Scholar
  • 14 Hampl H. et al. Recurrent hyperparathyroidism after total parathyroidectomy and autotransplantation in patients with long-term hemodialysis. Miner Electrolyte Metab 1991; 17: 256-260.
    PubMedGoogle Scholar
  • 15 Hampl H. et al. Long-term results of total parathyroidectomy without autotransplantation in patients with and without renal failure: An argument for total parathyroidectomyalone. Miner Electrol Metab 1999; 25: 161-170.
    Google Scholar
  • 16 Higgins RM. et al. Totalparathyroidectomy aloneor with autograft for renal hyperparathyroidism?. Q J Med 1991; 79: 323-332.
    Google Scholar
  • 17 Joy MS. et al. Outcomes of secondary hyperparathyroidism in chronic kidney disease and direct costs of treatment. J Manag Care Pharm 2007; 13: 397-411.
    PubMedGoogle Scholar
  • 18 Kaye M. et al. Elective total parathyroidectomy without autotransplant in end-stage renal disease. Kidney Int 1989; 35: 1390-1399.
    CrossrefPubMedGoogle Scholar
  • 19 Koonsman M. et al. Parathyroidectomy in chronic renal failure. Am J Surg 1994; 168: 631-634.
    CrossrefPubMedGoogle Scholar
  • 20 Korzets Z. et al. Total parathyroidectomy with autotransplantation in haemodialysed patients with secondary hyperparathyroidism--should it be abandoned?. Nephrol Dial Transplant 1987; 02: 341-346.
    Google Scholar
  • 21 Lin DT. et al. Incidence of inadvertent parathyroid removal during thyroidectomy. Laryngoscope 2002; 112 (04) 608-611.
    CrossrefPubMedGoogle Scholar
  • 22 Lindberg JS. et al. Cinacalcet HCl, an oral calcimimetic agent for the treatment of secondary hyperparathyroidism in hemodialysis and peritoneal dialysis: a randomized, double-blind, multicenter study. J Am Soc Nephrol 2005; 16: 800-807.
    CrossrefPubMedGoogle Scholar
  • 23 Ljutic D. et al. Long-term follow-up after total parathyroidectomy without parathyroid reimplantation in chronic renal failure. QJM 1994; 87: 685-692.
    PubMedGoogle Scholar
  • 24 Lorenz K. et al. Total parathyroidectomy without autotransplantation for renal hyperparathyroidism: experience with a qPTH-controlled protocol. World J Surg 2006; 30: 743-751.
    CrossrefPubMedGoogle Scholar
  • 25 Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med 2000; 343 (25) 1863-1875.
    CrossrefPubMedGoogle Scholar
  • 26 Neonakis E. et al. Results of surgical treatment of renal hyperparathyroidism. Arch Surg 1995; 130: 643-648.
    CrossrefPubMedGoogle Scholar
  • 27 Nicholson ML. et al. Parathyroidectomy in chronic renal failure: comparison of three operative strategies. J R Coll Surg Edinb 1996; 41: 382-387.
    PubMedGoogle Scholar
  • 28 Ockert S. et al. Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism. Langenbecks Arch Surg 2002; 387: 204-209.
    CrossrefPubMedGoogle Scholar
  • 29 Ritz E. Which is the preferred treatment of advanced hyperparathyroidism in a renal patient? II Early parathyroidectomy should be considered as the first choice. Nephrol Dial Transplant 1994; 09: 1819-1821.
    Google Scholar
  • 30 Rothmund M. et al. Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: a randomized trial. World J Surg 1991; 15: 745-750.
    CrossrefPubMedGoogle Scholar
  • 31 Rostaing L. et al. Changes in blood pressure and renal function following subtotal parathyroidectomy in renal transplant patients. Clin Nephrol 1997; 47: 248-255.
    PubMedGoogle Scholar
  • 32 Rostand SG, Drueke T. Parathyroid hormone, vitamin D, and cardiovascular disease in chronic renal failure. Kidney Int 1999; 56: 383-392.
    CrossrefPubMedGoogle Scholar
  • 33 Saunders RN. et al. Four gland parathyroidectomy without reimplantationin patients with chronic renal failure. Postgrad Med J 2005; 81: 255-258.
    CrossrefPubMedGoogle Scholar
  • 34 Schwarz A. et al. Decreased renal transplant function after parathyroidectomy. Nephrol Dial Transplant 2007; 22: 584-591.
    PubMedGoogle Scholar
  • 35 Shaha AR. et al. Parathyroid autotransplantation during thyroid surgery. J Surg Oncol 1991; 46: 21-24.
    CrossrefPubMedGoogle Scholar
  • 36 Stanbury SW. et al. Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet 1960; 01: 793-799.
    Google Scholar
  • 37 Stracke S. et al. Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure. Am J Kidney Dis 1999; 33: 304-311.
    CrossrefPubMedGoogle Scholar
  • 38 Stracke S. et al. Klinischer Verlauf nach totaler Parathyreoidektomie. Osteologie forum 1998; 04: 8-10.
    Google Scholar
  • 39 Stracke S. et al. Long-term outcome after total parathyroidectomy for the management of secondary hyperparathyroidism. Nephron Clin Pract 2009; 11: c102-c109.
    Google Scholar
  • 40 Stratton J. et al. Predictors of recurrent hyperparathyroidism after total parathyroidectomy in chronic renal failure. Nephron Clin Pract 2003; 95: c15-c22.
    PubMedGoogle Scholar
  • 41 Valderrabano F. et al. Report on management of renal failure in Europe, XXV, 1994 end stage renal disease and dialysis report. The EDTA-ERA Registry. European Dialysis and Transplant Association-European Renal Association. Nephrol Dial Transplant 1996; 11 l1 2-21.
    PubMedGoogle Scholar