Dynamics of Parathyroid Hormone Secretion After Total Parathyroidectomy and Autotransplantation

• Published in: World journal of surgery 2009-07, Vol.33 (7), p.1403-1407
• Main Authors: Conti-Freitas, Luiz Carlos, Foss-Freitas, Maria Cristina, Lucca, Leandro Junior, da Costa, Jose Abrão Cardeal, Mamede, Rui Celso Martins, Foss, Milton Cesar
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Bayes Theorem; Biological and medical sciences; Calcium - blood; Calcium - metabolism; Cardiac Surgery; Combined Modality Therapy; Female; Follow-Up Studies; General aspects; General Surgery; Graft Rejection; Graft Survival; Humans; Hypercalcemia; Hyperparathyroidism, Secondary - blood; Hyperparathyroidism, Secondary - etiology; Hyperparathyroidism, Secondary - surgery; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - diagnosis; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Parathyroid Gland; Parathyroid Glands - transplantation; Parathyroid Hormone - blood; Parathyroid Hormone - secretion; Parathyroid Tissue; Parathyroidectomy - methods; Probability; Prospective Studies; Risk Assessment; Secondary Hyperparathyroidism; Serum Calcium Level; Severity of Illness Index; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of endocrine glands; Thoracic Surgery; Transplantation, Autologous - methods; Treatment Outcome; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-009-0057-8

Background Secondary hyperparathyroidism is a common complication in uremic patients. Total parathyroidectomy combined with partial autotransplantation into brachioradialis muscle has been the preference among the options for surgical treatment. This study was designed to evaluate the reserve and ability of suppression of autotransplanted parathyroid tissue using dynamics tests. Methods We studied, prospectively, 12 patients in recent (RP) and late (LP) postoperative of total parathyroidectomy with autotransplantation. For analysis of the secretory reserve capacity, we induced hypocalcemia by ethylenediaminetetraacetic acid (EDTA) infusion. Furthermore, for analysis of the ability for parathyroid hormone (PTH) suppression, the hypercalcemia test was used, by intravenous administration of calcium in LP. Results In RP, there was a decrease in the average serum levels of PTH, phosphorus, and alkaline phosphatase, which ranged from 13 to 231 (87 ± 65) pg/ml, 2.3 to 6.2 (3.3 ± 1.1) mg/dl, and 77 to 504 (250 ± 135) U/L, respectively, similar to that observed in LP. The analysis of the average curve of variations in PTH during testing of the stimulus with EDTA showed lack of secretion in RP and partial response in LP. Impaired suppression ability of the graft in LP was observed in the test with intravenous calcium. Conclusions Total parathyroidectomy followed by partial autotransplantation was effective in reducing PTH serum levels in patients with terminal kidney disease. The elevation of serum calcium during the suppression test was not able to inhibit the autograft gland secretion of PTH. The assessment of parathyroid graft function demonstrated an inability to respond to the stimulus of hypocalcemia induced by EDTA, although there was a partial recovery, in late postoperative period.