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PubMed1996

Effects of parathyroidectomy and calcium supplementation on the pressor response to angiotensin II in conscious rats.

OBJECTIVE: We evaluated the effect of parathyroidectomy (PTx) and of calcium supplementation on the pressor response to angiotensin II (Ang II) in conscious rats. STUDY DESIGN: PTx and sham surgery were performed on 10-week-old male Wistar rats. The mean arterial pressure (MAP), heart rate, and the effective pressor dose of Ang II (EPD) which defined as the dose of Ang II required to elicit a rise of 20 mmHg in MAP, were evaluated in PTx and sham operated rats. Intracellular free calcium in platelets was assessed with the fluorescent dye, fura-2 acetoxymethyl ester. In addition, after administering a dose of supplemental calcium chloride, a 10, 20, or 40 mg/rat, we determined the changes in the MAP, EPD, and serum calcium level. RESULTS: The EPD in the PTx rats was significantly lower than the sham operated rats. The serum concentration of calcium in PTx was also significantly lower than the sham operated rats. A statistically significant negative relationship was observed between the EPD and intracellular free calcium in PTx rats. Following administration of 20 mg of calcium chloride (7.4 mg of elemental calcium) to the PTx rats, the EPD returned to the level seen in sham operated rats. CONCLUSION: Results suggest that a depletion of parathyroid hormone is associated with the pressor response to Ang II, and is involved in the regulation of intracellular free calcium.

Angiotensin II↗
PubMed1997

Effects of parathyroidectomy on induced renal failure in dogs.

OBJECTIVE: To determine the effects of parathyroid hormone (PTH) depletion on dogs with induced chronic renal failure. ANIMALS: 2 groups of 26 mixed-breed dogs of both sexes (13 were parathyroidectomized [PTX] and 13 had sham surgery). PROCEDURE: After surgical reduction of renal mass and PTX, dogs were selected for a 24-month period of study and monitored for clinical, hematologic, blood biochemical, and organ function status. On development of uremia or after 24 months, dogs were euthanatized, and tissues were examined. RESULTS: Higher survival rate and smaller decrement in renal function (glomerular filtration rate) were observed in PTX dogs, compared with those that had sham surgery, but values did not reach statistical significance. The PTX dogs remained hypocalcemic during the study and had lower serum Ca2+ X P product values. Regardless of parathyroid state, survivors and fatalities could be separated on the basis of serum Ca2+ X P product values. Parathyroidectomy did not prevent renal deposition of calcium, and renal lesions were poorly correlated with renal cortical calcium concentration. Abnormalities reported in dogs with renal failure, which were attributed to PTH (glucose intolerance, pulmonary hypertension), were not observed in PTX dogs or those that had sham surgery. CONCLUSIONS AND CLINICAL RELEVANCE: PTX had beneficial effects, but these were mediated via changes in mineral homeostasis rather than via direct effects of PTH. Results attributable to PTX were similar to those previously obtained by dietary restriction of phosphate intake.

Acidosis↗
PubMed1997

Changes in blood pressure and renal function following subtotal parathyroidectomy in renal transplant patients presenting with persistent hypercalcemic hyperparathyroidism.

The aims of this retrospective study were to assess renal function and blood pressure after subtotal parathyroidectomy (PTx) performed in renal transplant (RT) patients presenting with persistent hypercalcemic hyperparathyroidism. We identified 34 patients (group A) from our records who had undergone PTx between 1981 and 1994. Group A included 18 women and 16 men with a mean age of 45 +/- 12 years and a mean time on dialysis therapy of 102 +/- 59 months. Thirty of the patients received cyclosporine A (CsA) with or without steroids and/or azathioprine (AZA) and the remaining 4 patients received conventional therapy i.e. AZA and steroids. Twenty-three patients were treated for hypertension and 11 were normotensive. PTx was performed in 21 patients within the first year following renal transplantation and in 13 patients after this period. The study was divided into 3 periods: period 1-pre-PTx; period 2-the month following PTx; period 3-six months after PTx. Parameters were assessed for every patient in each of these periods. Results of group A were compared to those observed in 34 matched (control) RT patients (group B) who did not experience secondary hyperparathyroidism. PTx was associated with a significant decrease in parathyroid hormone (PTH) levels (45 +/- 8 pg/ml vs 338 +/- 54 pg/ml; p = 0.0002) and in calcemia (2.32 +/- 0.18 mmol/l vs 2.75 +/- 0.15 mmol/l; p = 0.0003) during period 3. However, we observed a significant increase in serum creatinine (124 +/- 30 mumol/l vs 110 +/- 25 mumol/l, p = 0.0016) in this group during period 3. Nevertheless, an increase in serum creatinine greater than 30% from baseline which still persisted six months after PTx was only observed in 8 patients (23.5%). There were more hypertensive patients in this latter subgroup (7 out of 8 i.e. 87.5%) than in the rest of the group (16 out of 26 i.e. 64.5%). Renal function impairment in group A was not related to pre-PTx SBP, DBP, MBP, calcemia, creatinine, CsA whole blood trough levels or PTH levels. Conversely, we did not observe significant changes in serum creatinine in the control group during the same periods. During period 2 there was a significant decrease in SBP (134 +/- 16 vs 140 +/- 16 mmHg; p = 0.046), DBP (81 +/- 9 vs 85 +/- 9 mmHg; p = 0.03) and MBP (99.5 +/- 10.5 vs 103.5 +/- 11 mmHg; p = 0.03) of group A. These differences persisted in period 3, with the exception of SBP, although they were no longer statistically significant. Following PTx we were able to discontinue (n = 4) or decrease (n = 4) antihypertensive drugs. In the control group baseline SBP, DBP and MBP were lower than in the PTx group, although the difference was statistically significant only for SBP (132.5 +/- 17 vs 140.5 +/- 16 mmHg; p = 0.05). During the study periods there was no significant changes in SBP, DBP or MBP in the control group. This study shows that RT patients with hypercalcemic hyperparathyroidism are often hypertensive (68%). Subtotal PTx is associated with a significant but transient decrease in SBP, DBP and MBP. Surprisingly we observe a significant and persistent increase in serum creatinine levels in 8 patients (23.5%), particularly in those presenting with hypertension before PTx. These results could reflect a dual effect of parathyroid hormone i.e. a balance between a vasodilating and hypertensive effect.

Adult↗
PubMed1997

[Total parathyroidectomy and autotransplantation of parathyroid tissue. Functional assessment of the autograft 5-10 years after surgery with the help of local ischemic blockade].

The aim of the present study was to assess the long-term function of autotransplanted parathyroid tissue. From the medical records of a consecutive series of 21 patients we found that during the time of follow-up (79 months) one patient developed parathyroid graft dependent recurrent hyperparathyroidism (HPT) and one patient suffered from hypoparathyroidism. Nine of the patients were available for measurements of the plasma concentrations of intact parathyroid hormone (iPTH) at rest and during a shortlasting ischaemic blockade of the autotransplant. In eight patients, the ischaemic blockade reduced the concentration of iPTH with on average 62% as compared to baseline values. In one patient, the autotransplant had been resected and as expected, iPTH did not change during ischaemic blockade. Our results indicate that total parathyroidectomy with autotransplantation provides a rational alternative to the surgical treatment of secondary HPT and that the ischaemic blockade manoeuvre seems suitable for assessment of the function of parathyroid autotransplants.

Adult↗
PubMed1997

[Secondary hyperparathyroidism and multiple vertebral brown tumors: cure after parathyroidectomy].

A 46 year old man was referred for severe left cruralgia and multiple vertebral cystic defects on CT-scan. He was treated by hemodialysis since 1987 for chronic renal failure secondary to focal and segmental glomerulosclerosis, diagnosed in 1960 on renal biopsy. Dialysis schedule consisted of 3 x 4 h/week with a polysulfone dialyser and 1.75 mMol Ca containing bicarbonate dialysate. On early 1995, the patient complained of back pain and cruralgia, which gradually worsened. Vertebral column CT-scan and MRI showed multiple lytic lesions expanding into the medullary canal. Biological hyperparathyroidism was present. To differentiate between hyperparathyroidism with brown tumors, malignancy and amyloid deposition, an iliac biopsy and a biopsy of a corporeal vertebral cyst were done. They showed florid hyperparathyroidism and brown tumors. The patient was submitted to surgical parathyroidectomy. Six months after surgery, cruralgia resumed, CT-scan and MRI showed refilling of the cysts by calcic material.

Glomerulosclerosis, Focal Segmental↗
PubMed1998

[Post-parathyroidectomy pseudogout in primary hyperparathyroidism].

We report two cases of pseudogout after parathyroidectomy by primary hyperparathyroidism. The pseudogout in each instance developed within 48 hours after parathyroid adenoma resection. Calcium supplement therapy, nonsteroidal anti-inflammatory drugs and colchicine (1 mg/day) suppressed the acute attack. The chondrocalcinosis is often asymptomatic or undiagnosed, for that, preoperative radiological studies of the knees, wrists and pelvis are recommended to screen for chondrocalcinosis. We advocate also, therapy with colchicine (1 mg/day, oral) in the prophylaxis of postoperative pseudogout.

Adenoma↗
PubMed1983

Subtotal parathyroidectomy for primary hyperparathyroidism. Long-term results in 292 patients.

Subtotal parathyroidectomy was performed in a consecutive series of 292 patients with primary hyperparathyroidism. We evaluated the long-term postoperative results during a period of 16 years. Patients ranged in age from 14 to 83 years and included 176 women and 116 men. Of these, 16% had a history of exposure to radiation in childhood or adolescence, while thyroid disease requiring some form of thyroidectomy coexisted in 91 (31%) of the patients. Histologic information on three or more parathyroid glands was obtained in 73% of the cases. We considered 285 patients (97.6%) cured after their first operation. The remaining seven patients (2.4%) had persistent hyperparathyroidism. However, five were cured after a sternum-splitting mediastinal exploration and one after a second neck exploration. The seventh remains hypercalcemic despite a subsequent mediastinal exploration. Temporary postoperative hypoparathyroidism occurred in 10% of our cases and permanent hypoparathyroidism in 1%. There have been no instances of recurrent hyperparathyroidism.

Adenocarcinoma↗
PubMedDate not supplied

Effect of dietary mineral and vitamin D content and parathyroidectomy on the plasma disappearance rate of 1,25-dihydroxyvitamin D3 in rats.

The plasma disappearance rate of 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3] was determined in rats after a single intravenous injection of the tritiated hormone. Tritiated 1,25-(OH)2D3 (120 Ci mmol-1) was administered to rats at a dose of 400 000 dpm kg-1 body weight and the animals were bled between 0 and 8 hours. The dose was estimated to produce negligible perturbations in endogenous plasma levels of 1,25-(OH)2D3. The plasma disappearance of 3H-1,25-(OH)2D3 occurred in two phases. The second phase plasma half-life of 1,25-(OH)2D3 in immature 25- to 35-day-old animals (4.7 hours) was significantly shorter than the second phase plasma half-life of maturing 49- to 65-day-old animals (8.0 hours). Phosphorus deprivation for 12 days significantly prolonged the second phase plasma half-life of 1,25-(OH)2D3 from a control value of 4.9 hours to 10.4 hours. Parathyroidectomy, regardless of the plasma calcium concentrations, shortened the second phase plasma half-life of 1,25-(OH)2D3 from control values of 9.1 hours to 5.0 hours. Calcium deprivation for 7 days did not alter the second phase plasma half-life of 1,25-(OH)2D3. Vitamin D deprivation for 5 weeks increased the second phase plasma half-life from 11.0 to 19.9 hours but the difference was not significant.

Age Factors↗
PubMed1989

The renal phosphate transport defect in normal mice parabiosed to X-linked hypophosphatemic mice persists after parathyroidectomy.

The X-linked hypophosphatemic (Hyp) mouse is a model for human X-linked hypophosphatemia. Surgical joining of normal to Hyp mice by parabiosis results in the normal mice developing low renal retention of phosphate and hypophosphatemia. These results suggest a humoral component to the renal defect. To test whether this component could be parathyroid hormone, surgical parathyroidectomy (PTX) or sham surgery was performed in mice 3 weeks after parabiotic union (n greater than 20 per group). After an overnight fast, PTX mice were hypocalcemic and hyperphosphatemic relative to sham-operated control mice. PTX normal mice joined to PTX Hyp mice were significantly lower in plasma phosphate and higher in fractional excretion of phosphate [U/P phosphate/(U/P creatinine)] when compared with PTX normal mice joined to other PTX normals. To test for more specific evidence of altered renal transport function, renal brush-border membrane vesicles (BBMV) were prepared from these mice, and phosphate and glucose uptakes were measured. The phosphate/glucose transport ratio was lower in BBMV from Hyp mice, joined to either normal mice or to Hyp mice, when compared with that from normal-normal pairs. Moreover, BBMV from normal mice joined to Hyp mice had a significantly lower phosphate/glucose uptake ratio than BBMV from normal mice joined to other normal mice, and their activity approached that of BBMV derived from Hyp mice. Glucose uptake in BBMV was unaffected by parabiosis or genotype. In summary, parabiosis of normal mice to Hyp mice resulted in the development of phosphaturia and decreased BBMV phosphate transport in the normal mice. The persistence of the phosphate transport defect in parathyroidectomized mice suggests that parathyroid hormone is not the humoral factor contributing to these results.

Alkaline Phosphatase↗
PubMed1990

Effect of parathyroidectomy on aluminum toxicity and azotemic bone disease in the rat.

In maintenance dialysis patients, low-turnover osteomalacia and aplastic bone disease are generally attributed to aluminum toxicity. Both groups of patients have a relative deficiency of PTH. The reason for the development of osteomalacia versus aplastic bone disease is unclear. The present study was performed to evaluate whether parathyroidectomy (PTX) modifies the effect of aluminum administration on bone histology in renal failure. Seven groups of pair-fed rats were studied: normals (N); renal failure (RF); RF + PTX; PTX; RF + aluminum (AL); RF + PTX + AL; and PTX + AL. Aluminum was administered intraperitoneally 5 days/week for 6 weeks. All groups were sacrificed at 6 weeks. Renal failure increased the serum calcium in both the parathyroid intact (RF versus N, 11 +/- 0.1 versus 10 +/- 0.3 mg/dl, X +/- SEM, P less than 0.05) and calcium-supplemented PTX groups (PTX + RF versus PTX, 9.7 +/- 0.2 versus 9.2 +/- 0.2 mg/dl, P less than 0.05). After PTX, aluminum administration increased the serum calcium (PTX + AL versus PTX, 9.8 +/- 0.3 versus 9.2 +/- 0.2, P less than 0.05, and PTX + RF + AL versus PTX + RF, 10.8 +/- 0.1 versus 9.7 +/- 0.2 mg/dl, P less than 0.05). In rats with renal failure receiving aluminum, PTX decreased osteoid volume and surface but not osteoid thickness. Rats receiving aluminum did not mineralize bone. Additionally, in PTX rats receiving aluminum, renal failure per se increased osteoblast surface, osteoid surface, osteoid volume, and osteoclast number.(ABSTRACT TRUNCATED AT 250 WORDS)

Aluminum↗
PubMed1988

Hormonal regulation of muscle protein catabolism in acutely uremic rats: effect of adrenalectomy and parathyroidectomy.

To examine the role of glucocorticoids and PTH on the enhanced protein catabolism of acute uremia, rats were rendered uremic and had their adrenals or their parathyroid glands concomitantly removed. Adrenalectomy resulted in a marked reduction of urea generation in uremic animals due to decrease of myofibrillar protein breakdown as indicated by lower serum levels of Nt-methylhistidine and a reduction in the activity of the myofibrillar proteinase from skeletal muscle. This reduced urea formation was accompanied by marked hypoglycemia. Parathyroidectomy, on the other hand, caused no change of those parameters of protein catabolism, suggesting that PTH does not account for the protein degradation observed in acutely uremic rats.

Acute Disease↗
PubMed1988

Somatosensory evoked potentials in patients with hypocalcaemia after parathyroidectomy.

The effects of hypocalcaemia on somatosensory evoked potentials (SEPs) were studied in five patients after parathyroidectomy. Despite normal latencies the mean value of amplitudes of the SEPs in hypocalcaemic patients was greater than that in normocalcaemic subjects. Recovery functions of the SEPs showed a significant decrease in hypocalcaemic patients at interstimulus intervals of about 10 ms compared with those in normocalcaemic patients and in normal volunteers. Recovery functions appear to be a valid indicator of synaptic efficacy, especially for evaluation of the reduction in conduction efficacy of the central nervous system in hypocalcaemia.

Aged↗
PubMed1988

[Parathyroidectomy and autotransplantation in renal hyperparathyroidism. I. Morphologic studies for tissue selection].

During total parathyroidectomy and autotransplantation 140 enlarged glands were removed in 35 hemodialyzed patients (normocalcemic: n = 14; hypercalcemic: n = 21). The cross-sections of all glands were classified intraoperatively. Diffuse hyperplastic (type 1) and nodular hyperplastic (type 2) glands could be distinguished. Using a stereo-magnifier (magnification: x 10 -x 16), type 1a- (stromal fat cells!) and type 1b- glands (without stromal fat cells!) could be differentiated. Those areas were also found between the nodules of type 2-glands. Significantly, nodular hyperplastic glands predominated in hypercalcemic patients (chi 2-Test: p less than 0.001). The colour of the nodules on the cross-sections of type 2-glands correlated with the predominating cell type ("dark": nodule of oxyphile cells; "medium": nodule of chief cells; "light": nodule of 'degenerating' oxyphile cells). As sign of proliferation the mitotic index was elevated (greater than 1:10,000) in type 1b-glands, in type 1b-like areas and in nodules of type 2-glands. These areas should not be used for autotransplantation.

Adipose Tissue↗
PubMed1979

Proximal and distal intestinal calcium transport in vitro as influenced by low calcium diet, uremia, parathyroidectomy and 1,25-dihydroxycholecalciferol treatment in rats.

Duodenal and ileal in vitro calcium transport was studied in 5/6 nephrectomized rats. Low calcium diet resulted in an increase of the duodenal calcium transport in kidney intact control animals but not in uremic rats; the ileal transport however increased in controls as well as in uremic rats. Parathyroidectomy decreased this adaptive transport at both gut sites in intact and uremic rats. Supplementation with low doses of 1,25-dihydroxycholecalciferol (1,25-DHCC) restored the duodenal transport in nephrectomized rats to the level of controls; nephrectomized plus parathyroidectomized animals increased the duodenal but not the ileal calcium transport. A close correlation between calcium transport and serum phosphorus concentrations of all groups of rats studied points towards a possible role of phosphate for intestinal calcium transport. It is concluded that duodenal calcium transport is regulated by the parathyroid-1,25-DHCC axis with 1,25-DHCC as effector; ileal calcium transport in contrast is regulated by combined direct effects of 1,25-DHCC and parathyroid hormone, the latter being essential for active transport.

Animals↗
PubMed1982

Decreased mineralization in hemodialysis patients after subtotal parathyroidectomy.

Many hemodialysis patients undergo subtotal parathyroidectomy (sPTx) because of the complications of severe secondary hyperparathyroidism. In some patients, however, renal osteodystrophy fails to regress. In uremia, the high levels of circulating immunoreactive parathyroid hormone (iPTH) which accompany osteitis fibrosa are associated with accelerated bone formation. After sPTx, the fall in iPTH may decrease mineralization and increase osteoid formation. Bone histomorphometry, densitometry, and serum biochemical determinations were done in 20 patients on regular maintenance hemodialysis and after sPTx in 3 additional patients. Densitometry at the radial diaphysis was inversely related to osteoid volume so that low bone mineral content indicated excess osteoid. Elevated serum alkaline phosphatase activity was associated with osteitis fibrosa. Tetracycline double labels identified 5 patients with an increased rate of mineralization. Levels of iPTH and serum phosphorus were positively correlated to the mineralization rate. The fall in iPTH after sPTx was accompanied by a reduction in osteitis fibrosa and decreased mineralization. The nonosteoblastic osteoid became more abundant. After sPTx some hemodialysis patients may convert the osteitis fibrosa to a poorly treatable low turnover osteomalacia.

Adult↗
PubMed1989

Effects of parathyroidectomy on tissue calcium, phosphorus, magnesium, and copper concentrations in aluminum-loaded uremic rats.

Rats were subjected to a two-stage 5/6 nephrectomy and treated with Al for 2 and 4 wk with a cumulative dose of 4.2 and 8.4 mg of Al, respectively. Other animals were parathyrectomized (PTx) and loaded with 8.4 mg of Al for 4 wk. Total Al, Ca, P, Mg, and Cu contents were analyzed in the liver, kidney, and bone by inductively coupled plasma atomic emission spectrometry (ICP-AES). The results showed that Al given to growing uremic rats significantly increased the content of Al in the liver, kidney, and bone. Moreover, Al treatment increased the liver and kidney Ca levels and decreased the Ca and P values in bone. Previous parathyroidectomy significantly reduced Al accumulation within organs and changes in the Ca and P levels in the bone, liver, and kidney. The result was not influenced by different degrees of renal failure.

Aluminum↗