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PubMed1987

[A case report: primary hyperparathyroidism--comparison before and after parathyroidectomy by oral calcium tolerance test].

To evaluate the cause of hypercalciuria, we carried out the oral calcium tolerance test before and after parathyroidectomy in a patient with primary hyperparathyroidism who had recurrent and multiple nephrolithiasis. Preoperative laboratory examination showed hypercalcemia, hypophosphetamia, hypercalciuria, decrease in % tubular reabsorption of phosphorus and strikingly elevated urinary cyclic AMP excretion. The oral calcium tolerance test indicated a significantly greater increase in serum calcium (delta serum calcium: 1.4 mg/dl vs 0.8 mg/dl) and a significantly greater suppression of urinary cyclic AMP excretion (delta U-cyclic AMP:-3.56 moles/gCre vs-1.17 moles/gCre) before parathyroidectomy than after. These results showed that hypercalciuria in this case was induced not only by the significant increase in the filtrated load of calcium but by the reduction in the resorption of calcium in the distal tubule caused by the significantly suppressed parathyroid hormone effect.

Administration, Oral↗
PubMed1986

The role of parathyroid function and parathyroidectomy in the outcome of aluminium-related dialysis encephalopathy.

Aluminium (Al) intoxication in patients with chronic renal failure may lead to osteomalacia, microcytic anaemia, and encephalopathy. It has been suggested that the expression of Al toxicity may be related to the function of the parathyroid glands. The purpose of this study was to determine whether the functional state of the parathyroids influenced the evolution of Al-related encephalopathy in Al-intoxicated haemodialysed patients. The patients were subdivided into two groups according to outcome: group I patients (n = 6) had died with the clinical feature of severe cerebral dysfunction; group II patients (n = 15) had a favourable outcome with partial or complete recovery. The degree of hyperparathyroidism, as evaluated by plasma biochemistry and bone histology, was comparable in both groups. Three patients of group I and five of group II underwent parathyroidectomy. Before the clinical onset of encephalopathy the duration of Al overload in group I was not different from group II, but after its onset patients of group I were intoxicated significantly longer (8 months +/- 6.6) than those of group II (1.5 months +/- 1.9). This study shows that, in uraemic patients with Al-related encephalopathy, parathyroid function and parathyroidectomy do not play an essential role in clinical outcome. The duration of Al intoxication following the first signs of encephalopathy appears to be the major prognostic element.

Adult↗
PubMed1987

Parathyroidectomy increases peripheral vascular responsiveness to exogenous noradrenaline in the uraemic rat.

The effect of surgical parathyroidectomy and/or cyclo-oxygenase inhibition on noradrenaline-induced blood pressure (BP) responses were investigated in a rat model of chronic uraemia. The blood pressure responses to noradrenaline were significantly lower in uraemic rats when compared with the responses of non-uraemic animals. Blood pressure responses of previously parathyroidectomized uraemic rats were significantly greater than sham-operated uraemic rats, as were the responses of uraemic rats pretreated with the cyclo-oxygenase inhibitor, indomethacin. Pretreatment of uraemic rats with both indomethacin and parathyroidectomy improved blood pressure responses to a degree equal to either manoeuvre alone, but did not exhibit an additive effect. These data suggest a role for parathyroid hormone and prostaglandins in the pathogenesis of the diminished noradrenaline responsiveness in uraemia, and suggest a common mechanism.

Animals↗
PubMedDate not supplied

[Ultrastructure of the fascicular area of the adrenal cortex after parathyroidectomy in the rat].

Electron microscopic investigation of the adrenocortical fascicular zone was conducted to determine serum calcium content in control and parathyroprivic random bred adult rats on the 5th, 15th and 30th days after parathyroidectomy. During the entire experiment calcium content was lowered. There were no marked changes in the ultrastructure of the secretory cells of the fascicular zone on the 5th day. In experimental animals killed on the 15th day after operation adrenocortical ultrastructural changes indicated structural-functional activity as well as destructive processes in the secretory apparatus. On the 30th day after parathyroidectomy destructive processes prevailed in most adrenocorticocytes. Considerable shifts were noted in the system of the hemocirculatory bed of the adrenocortex of parathyroprivic animals.

Adrenal Cortex↗
PubMedDate not supplied

Influence of parathyroidectomy on aortic responsiveness to noradrenaline in spontaneously hypertensive rats.

The development of hypertension was delayed and attenuated after removal of the parathyroid glands in 6 weeks-old spontaneously hypertensive rats (SHR). The influence of parathyroidectomy on vascular contractile responses to noradrenaline was investigated on isolated aortic rings. An increased sensitivity to cumulative concentrations of noradrenaline in physiological solution containing 1.25 mmol/l calcium was observed 22 weeks after surgery in aorta from parathyroidectomized rats as compared to control rats. In response to a single concentration of noradrenaline (10(-5) mol/l), aortae from parathyroidectomized SHR rats compared to controls displayed an increased tonic component. No difference in contractile responses to calcium was observed between aortae from control and parathyroidectomized rats. These data are not specific for hypertension in SHR since after parathyroidectomy similar results were also obtained on normotensive Wistar rats. In addition, 8 weeks-old Wistar rats contractile responses evoked by cumulative concentrations of noradrenaline in solution containing 0.6 mmol/l calcium were decreased in aortae from both control and parathyroidectomized rats. Moreover, calculated contractile responses were similar in parathyroidectomized and control rats for the in vivo levels of ionized calcium. From these results it appears that removal of parathyroid glands in both spontaneously hypertensive and normotensive rats, leads to an increase in the in vitro vascular reactivity to noradrenaline, and the extracellular calcium concentration seems to play a key role in this mechanism.

Animals↗
PubMed1986

Parathyroid hormone: before and after parathyroidectomy.

The clinical value of measuring serum immunoreactive parathyroid hormone (iPTH) for the diagnosis of primary hyperparathyroidism is sometimes debated, and the clinical significance of an elevated postoperative serum iPTH level is unknown. Therefore we studied 141 consecutive patients with primary hyperparathyroidism before and after parathyroidectomy to determine the clinical value of measuring serum iPTH by a mid-region-specific radioimmunoassay. Eighty-eight percent of the patients with primary hyperparathyroidism had an absolute increase in the level of serum iPTH (greater than 40 microliter Eq/ml) before surgery, and the remaining patients had an inappropriately increased level of serum iPTH for the simultaneous serum calcium level. Preoperative serum iPTH level correlated positively with serum calcium level and parathyroid tumor size. Postoperative elevation of serum iPTH level was common (as high as 40%) and was associated with higher preoperative levels of blood urea nitrogen, serum creatinine, and alkaline phosphatase and larger tumors. An elevated postoperative serum iPTH level without hypercalcemia did not indicate a failed parathyroidectomy, whereas negative parathyroid exploration and postoperative hypercalcemia were the best predictors of persistent hyperparathyroidism. We conclude that preoperative serum iPTH measurement is a very sensitive diagnostic test for primary hyperparathyroidism, but postoperative serum iPTH measurement is not a good predictor for persistent or recurrent hyperparathyroidism.

Adult↗
PubMed1985

DNA histogram of parathyroid tissue in determining extent of parathyroidectomy.

In an attempt to better define hyperplasia from adenoma and for more accurate discernment of grossly normal but histologically abnormal presumed hyperfunctioning gland, parathyroid tissue obtained at operation was subjected to flow cytometric analysis producing DNA histogram. Seventeen abnormal specimens and seven normal specimens obtained from parathyroidectomy cases were placed in RPMI 1640 culture medium, treated to produce a monodispersed cell suspension, and stained with propidium iodide fluorescent dye to provide a measure of DNA content that could be graphically demonstrated. All cell cycles for affected cell populations could be demonstrated on DNA histogram in the G0G1, S, and G2M phases. Proliferative index was arbitrarily derived by combining percentages of G2M plus S phases. It was apparent that the value so derived showed a tendency for higher value for the abnormal parathyroid tissue but the overlap was sufficient so that no specific discriminating value could be placed on DNA histogram. While flow cytometry may not be of significant use in intraoperative identification of abnormal parathyroid tissue, the values obtained may indicate that a spectrum of activity occurs in hyperparathyroidism that cannot be fully appreciated at the present time and that may in the light of incomplete knowledge manifest itself in the clinical state of hyperparathyroidism and hypercalcemia. The findings of our flow cytometry study may indeed lend credence to the view that all hyperparathyroidism represents a four-gland hyperfunction although this does not support as a consequence routine subtotal parathyroidectomy but should stimulate further inquiry into the pathogenesis of primary hyperparathyroidism.

Adenoma↗
PubMed1979

Parathyroidectomy in chronic renal failure.

During the period 1971-1976, subtotal parathyroidectomy was performed on 34 patients with chronic renal failure, representing 8% of all uraemic patients treated on the Renal Ward. Preoperative treatment of renal failure was conservative therapy in 6, haemodialysis in 20 and renal transplantation in 8 patients. The operation was indicated by grave clinical symptoms (pruritus, bone pains and mental disturbances), gastric ulcer and radiological abnormalities (osteoporosis, fractures, subperiosteal resorption and metastatic calcifications). The serum immunoreactive parathyroid hormone was determined in 13 cases, and the value was elevated in all. The serum calcium level was elevated in 8 out of 34 cases. Less than 500 mg of parathyroid tissue was removed in 12 cases, between 500 and 6000 mg in 19 and over 6000 mg in 3. Nodular hyperplasia was present in 11 patients, diffuse hyperplasia in 23. Postoperatively marked falls in serum parathyroid hormone and serum calcium values were observed. The bone pains, pruritus and mental disturbances were alleviated, and the general condition was favourably influenced. The operation had a lesser and more retarded effect on the radiological changes. Complete recovery was only achieved with successful renal transplant. Parathyroidectomy often had a favourable effect on the grave symptoms and may, therefore, be considered in some cases of severe hyperparathyroidism secondary to chronic renal failure.

Adolescent↗
PubMed1979

Post-parathyroidectomy psychosis: clinical and research implications.

The case of a 52-year-old female who suffered a post-parathyroidectomy pyschosis is presented and similar cases from the literature are reviewed. Studies of calcium and mangnesium metabolism in mental illness are reviewed, as fluctuations of these ions are felt to be involved in the pathogenesis of this condition. A definable syndrome of post-parathyroidectomy psychosis may exist and the implications of such a syndrome are discussed.

Calcium↗
PubMed1979

Results of parathyroidectomy for autonomous hyperparathyroidism.

Autonomous hyperparathyroidism occurred in 15% of 152 patients maintained by long-term home dialysis during the past nine years. Twenty-two patients with elevated serum parathormone levels and progressive bone disease in the presence of normal serum phosphate and calcium levels were treated by subtotal parathyroidectomy. All had parathyroid hyperplasia. Eighteen of the 22 patients are presently alive and undergo dialysis. Symptoms of bone pain, pruritus, and muscle cramps had improved in three fourths of the patients. The serum parathormone level decreased from a preoperative average of 576 muLEq/mL to an average of 188 muLEq/mL postoperatively. All 18 patients, observed for six to 77 months, showed improvement in x-ray films of their bone disease. The autonomous hyperparathyroidism of end-stage renal disease is corrected by subtotal parathyroidectomy, and the effect is sustained.

Adult↗
PubMed1979

[Subtotal parathyroidectomy in the advanced stages of renal osteodystrophy].

In 7 haemodialysis patients with progressing renal osteopathy a partly subtotal, partly total parathyroidectomy was carried out. Postoperatively in all cases a clinical improvement developed, which, however, in part was only transient. The laboratory parameters showed a rapid tendency to normalisation, the X-ray diagnostic finding and the bone mineral content remained essentially unchanged, also the histological skeletal findings. The results are compiled in form of tables. The value of the diagnostic measures which should precede a subtotal parathyroidectomy is discussed. At present the different postoperative courses apparently cannot be prospectively estimated with the help of the hitherto usual diagnostic measures. On the basis of the partly good results and of the operation risk which is to be thoroughly demanded of a haemodialysis patient it seems that after having used all conservative possibilities the surgical interventions nevertheless indicated in progressing renal osteopathy.

Adult↗
PubMed1977

[Reduction of the hyperparathyroidism of uraemia by total parathyroidectomy followed by partial autograft (author's transl)].

In 3 cases, total parathyroidectomy, with graft of fragments of one of the glands into the forearm gave rapid correction of the clinical and biological disorders associated with secondary hyperparathyroidism. The secretion of parathyroid hormone by the autograft was confirmed by radioimmunoassay on brachial vein samples. This technique appears to be more satisfactory than 7/8 parathyroidectomy, the postoperative course of which is not always free of complications, which involves a risk of necrosis of the gland fragment left in place and in which reoperation is difficult.

Adult↗
PubMed1982

Reoperative parathyroid surgery for primary hyperparathyroidism caused by multiple-gland disease: total parathyroidectomy and autotransplantation with cryopreserved tissue.

Between September 1975 and June 1980, 27 patients with primary hyperparathyroidism caused by multiple-gland disease underwent reoperative parathyroid surgery at the National Cancer Institute. In an effort to minimize persistence and recurrence we adopted a strategy of attempting total parathyroidectomy. Immediate autotransplantation was not performed, but rather tissue was assessed in vitro for suppressibility and was cryopreserved. Patients with prolonged postoperative hypoparathyroidism underwent autotransplantation with cryopreserved tissue. Of 26 surviving patients, 23 (88%) were cured of hypercalcemia. Although 13 had hypoparathyroidism at the time of discharge, 4 of these 13 no longer required calcium or vitamin D within 1 year. At follow-up 17 were normocalcemic without medication (14 without and 3 with autografts). Thirteen patients had four or five glands removed. Two of these remain hypercalcemic, and at follow-up nine were normocalcemic without medication (seven without and two with autografts). Patients with multiple-gland disease, even those undergoing total parathyroidectomy, remain at risk for persistent or recurrent hypercalcemia. Such patients do no inevitably acquire hypoparathyroidism, and normocalcemia in patients undergoing immediate autotransplantation need not be attributed to the autograft. Selective, deferred autotransplantation with cryopreserved tissue prevents confusion regarding the source of postoperative hypercalcemia should it occur, minimizes the risk of graft-dependent hypercalcemia by restricting autotransplantation to those truly in need of additional tissue, and can effectively manage hypoparathyroidism.

Female↗
PubMed1978

Improvement in the anemia of hemodialyzed patients following subtotal parathyroidectomy. Evidence for the role of secondary hyperparathyroidism in the etiology of the anemia of chronic renal failure.

An increase in the blood hemoglobin concentration was found in four of five patients on chronic hemodialysis following subtotal parathyroidectomy performed for the treatment of incapacitating osteodystrophy. In a sixth hemodialyzed patient, there was a striking increase in the hemoglobin level following treatment with 1alpha-hydroxycholecalciferol with suppressed parathyroid overactivity. It is concluded that surgical or "chemical" parathyroidectomy seems to be associated with improvement of the anemia of patients with chronic renal failure.

Adult↗
PubMed1983

The advantage of measurement of intact PTH in the prediction of clinical response and calcium metabolism after subtotal parathyroidectomy for renal osteodystrophy.

As previously reported, the circulating half-life of carboxyterminal PTH is greatly prolonged in renal failure (mean t1/2 33.20 +/- 10.18 hrs), while intact PTH is much less affected (t1/2 less than one hour). Preoperative intact PTH levels were strongly predictive of clinical response to subtotal parathyroidectomy, and may help to differentiate the nature of metabolic bone disease in symptomatic dialysis patients. Intact PTH levels showed strong correlation with postoperative calcium metabolism, allowing prediction of extent of postoperative hypocalcemia. Carboxyterminal PTH levels, influenced by renal function as well as by functional parathyroid state, were poorly predictive of response to parathyroidectomy and not correlated with postoperative calcium metabolism.

Adult↗
PubMedDate not supplied

Total parathyroidectomy and renal function in patients with chronic renal failure.

5 patients with nonterminal renal failure who underwent total parathyroidectomy at Sydney Hospital over a 4-year period showed significant postoperative deterioration in renal function. In 4 of these patients, this deterioration occurred at a time when they were receiving supplements of calcium and 1,25-dihydroxyvitamin D3 but when close monitoring failed to show any evidence of hypercalcemia. In 1 patient the deterioration in renal function was clearly associated with hypercalcemia. We suggest that parathyroidectomy in nondialyzed patients be reserved for those with severe symptomatic hyperparathyroidism and that wherever possible the need for large doses of calcium and vitamin D be avoided.

Adult↗
PubMed1983

Total parathyroidectomy and autotransplantation of parathyroid tissue for renal hyperparathyroidism. A one- to six-year follow-up.

From 1975 to 1981 total parathyroidectomy and parathyroid autotransplantation were carried out in 62 patients for renal (secondary) hyperparathyroidism. The paper reports on 46 patients followed for one to six years (mean 2.2 +/- 1.2 years). Forty-one were on chronic hemodialysis, three were predialytic, two had a functioning renal graft. There have been two different groups of indications: one in which hypercalcemia was the main reason for surgery (59%), the other in which severe renal osteopathy (bone pain, radiologic and histologic signs, elevation of alkaline phosphatase, and parathyroid hormone) was observed. Among 45 patients not previously operated on for hyperparathyroidism, five parathyroid glands were removed in three patients, four glands were removed in 36 patients, and three glands were removed in five patients. In one patient previously operated (thyroid surgery), two glands were removed. Tissue was immediately autografted into a forearm muscle. One patient (two glands removed) received a cryopreserved tissue six months after neck exploration. An improvement of bone pain, pruritus, and radiologic signs of renal osteopathy was noted in about 80% of patients. At one to six years no patient was hypercalcemic, in 44 patients the grafted tissue was functioning normally after an average time of 5.8 +/- 1.4 months. One patient is still on low-dose, supplemental therapy for slight hypocalcemia 14 months after autotransplantation. In another patient a part of the grafted tissue was removed for increasing parathyroid hormone levels. Serum concentration of alkaline phosphatase and serum parathyroid hormone decreased after surgery. One- to six-year results after total parathyroidectomy and autotransplantation for renal hyperparathyroidism are considered to be extremely satisfactory.

Adolescent↗