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PubMed1983

The effects of parathyroidectomy on the development of nephrocalcinosis in rats fed phosphate-supplemented and unsupplemented diets containing alpha protein.

The effects of parathyroidectomy (PTX) on the development of nephrocalcinosis in rats fed a diet containing alpha protein were investigated for the purpose of determining whether the nephrocalcinosis was phosphate-induced. PTX completely prevented the occurrence of nephrocalcinosis in rats fed a phosphate-supplemented commercial laboratory diet for 4 weeks. However, PTX did not completely prevent the occurrence of nephrocalcinosis in rats fed a phosphate-supplemented alpha protein diet. Several calciferous deposits were found in the inner medulla. The same was also found in rats that underwent sham operations and PTX rats fed the basal alpha protein diet. Total renal calcium and phosphorous levels in these three groups were also similar and were about twice as great as those in corresponding groups fed phosphate-supplemented and unsupplemented commercial laboratory diets. Therefore, we conclude that the nephrocalcinosis in rats fed a basal alpha protein diet is not induced by PTH or excess phosphate, but is induced by some other factor associated with the diet.

Animals↗
PubMed1984

Total parathyroidectomy: parathyroid hormone levels and supernumerary glands in hemodialysis patients.

Determination of PTH levels by radioimmunoassay can be employed for the accurate monitoring of the completeness of parathyroidectomy and the functioning of transplanted parathyroid tissue in chronic renal failure but the successful use of the approach requires accurate knowledge of the specificity of the assay and appropriate timing of postparathyroidectomy PTH measurements. In our series, 33% of grafts functioned within 9 days of implantation. The incidence of five, or more, glands in 25% of patients and the persistence of detectable PTH levels, postoperatively, in four patients after removal of four or more glands suggest that hypocalcemic stimulation in uremia may cause parathyroid rests ( parathyromatosis ) to enlarge. These findings also suggest that particular attention should be paid to finding a possible 5th or 6th parathyroid gland in uremic patients requiring surgical treatment of hyperparathyroidism.

Adult↗
PubMed1980

[Tertiary hyperparathyroidism following kidney transplants in man treated by parathyroidectomy and parathyroid autografts. A report on 8 cases (author's transl)].

Hyperparathyroidism developed in 8 of 76 patients two months to 4 years after functional Kidney transplants, the most constant manifestation being a hypercalcemia. Raised PTH levels were present in all 7 patients in whom they were measured. The 8 patients were treated by total parathyroidectomy, followed in 7 cases by an autograft of a parathyroid fragment into the muscle off one forearm, according to the technique described by wells. Blood calcium levels became normal in all cases after one month. PTH levels also returned to normal except in one case where rejection of the Kidney graft caused a reduction in renal function. Comparing PTH levels in the venous blood on the side of the autograft with that on the opposite side demonstrated that the parathyroid graft was actively secreting.

Calcium↗
PubMed1981

[Tertiary hyperparathyroidism after renal transplantation in man. Treatment by parathyroidectomy and auto-graft. Eight cases (author's transl)].

In a series of 76 functional renal transplantations we noted 8 cases of hyperparthyroidism occurring in periods ranging from 2 months to 4 years. Hypercalcaemia was the most constant manifestation. PTH was raised in the 7 subjects in whom it was measured. Eight patients underwent total parathyroidectomy followed in 7 of them by auto-graft of a fragment of parathyroid into a forearm muscle according to the technique of Wells. The operation was followed in all cases by normalisation in blood calcium levels after the 1st month. Serum PTH levels also returned to normal apart from in one case where renal function was impaired because of rejection of the renal graft. Comparative estimations of PTH in venous blood from the side of the auto-graft and the opposite side showed that the parathyroid graft was functioning.

Calcium↗
PubMed1980

[Influence of parathyroidectomy on the anemia of hemodialysis patients (author's transl)].

The influence of parathyroid hormone (PTH) as a potential toxin responsible for the anemia in hemodialysed patients is suggested by the fact that 6 patients out of 12 showed improvement of their hematocrit four months after parathyroidectomy. Blood iron levels as well as calcemia, phosphoremia and hematocrit before surgery are not indicative of improvement following the intervention. A direct toxicity of PTH on erythropoiesis seems likely.

Anemia↗
PubMed1981

Total parathyroidectomy and autotransplantation.

Total parathyroidectomy and autotransplantation of tissue to the forearm was practiced in 50 chronic renal failure patients as treatment for secondary hyperparathyroidism. Four hyperplastic glands were removed in all cases. Followup observation ranged from 3 to 42 months. Serum parathyroid hormone, alkaline phosphatase, calcium and phosphorus levels decreased significantly following the procedure (P less than 0.005) and remained stable during the period of observation. Significant bone pain present in 26 patients improved or ceased in 19; pruritus, present in 39 patients, universally improved. Strong radiographic suggestion of secondary hyperparathyroidism, present in 38 patients, improved or disappeared in 17. Three patients remained functionally hyperparathyroid, requiring further tissue removal. Autograft function 3 to 7 days after transplantation was demonstrated in 3 cases by differential parathyroid hormone concentration determinations. Essentially all patients experienced symptomatic improvement after surgery and most showed objective evidence of improved calcium-phosphorus metabolism and bone healing.

Adolescent↗
PubMed1981

Complications to subtotal parathyroidectomy.

Seventy-three patients were operated on for confirmed hyperparathyroidism. Identification of all glands was done by 1/3 biopsies for histopathologic examination on frozen section during the operation. In cases of adenoma only, the adenoma was removed except for the biopsies. In cases of hyperplasia, subtotal resection was made, leaving between a half-gland and a whole gland. The frequency of complications was analysed. Temporary hypocalcemia occurred in a similar frequency in both adenoma and hyperplasia groups. Permanent hypocalcemia was present in only one patient. At follow-up 3-5 years after operation, 98.6% of the patients were normocalcemic. Ionized and total serum calcium were normalized 3 months after operation and remained so for the rest of the follow-up period. Serum phosphate, serum magnesium and serum parathormone also remained normal. Thus identification of parathyroid glands with biopsies or subtotal parathyroidectomy in cases with hyperplasia did not increase the risk of postoperative complications.

Adult↗
PubMed1977

The response of heart rate to isoproterenol in hemodialyzed patients before and after parathyroidectomy.

The response of the heart rate to intravenous isoproterenol was studied in seven chronic hemodialysis patients with severe hyperparathyroidism, before and after subtotal parathyroidectomy (PTX). Before PTX, significantly higher doses of isoproterenol were needed to achieve a standardized increase in heart rate when compared with the doses needed following PTX. A similar difference was observed before and after removal of a parathyroid adenoma in an additional nonuremic patient with primary hyperparathyroidism. This decreased cardiac responsiveness to a beta-adrenergic stimulus seemed to be related to the hyperparathyroid state.

Adenoma↗
PubMed1977

The role of the parathyroids for the adaptation to a low calcium intake. 5. The long-term effect of parathyroidectomy on the adaptation to a low calcium intake in adult rats with special reference to the metabolism of vitamin D.

One-year-old selectively parathyroidectomized rats showed a normalization of their plasma calcium level to above 4.1 mEq/l in 38% within 18 weeks on a normal dietary intake of calcium and inorganic phosphate but low in vitamin D. On a low level of dietary calcium, normalization did not occur in any of the parathyroidectomized animals. The conversion of 25-hydroxycholecalciferol into the active metabolite of vitamin D, 1,25-dihydroxycholecalciferol, by the kidneys was stimulated by a low dietary intake of calcium in intact animals and the accumulation of this metabolite was increased in small intestine mucosa. This adaptory increase in the level of intestinal 1,25-dihydroxycholecalciferol was not disturbed by selective parathyroidectomy, nor the synthesis by the kidneys. The synthesis reached a limit above which no further increase occurred despite the prevailing hypocalcemia possibly through an influence of the concomitant hyperphosphatemia. The renal synthesis and intestinal accumulation of 1,25-dihydroxycholecalciferol were directly related to the intestinal net absorption of dietary calcium, which we have reported on previously. Although increased, the endogenous level of 1,25-dihydroxycholecalciferol was too low to accomplish mobilization of skeletal calcium necessary for adaptation to a low calcium intake, as we have reported elsewhere. Thus, for adaptation skeletal calcium reserves must become mobilized through stimulated parathyroid activity with resulting osteoporosis. The parathyroids were found to have no direct regulatory influence upon the synthesis of 1,25-dihydroxycholecalciferol.

Adaptation, Physiological↗