Petrytsya R. Diagnosis and surgical treatment of secondary and tertiary hyperparathyroidism

Among 180 patients with chronic renal insufficiency (CRI) secondary hyperparathyroidism (HPT) has revealed in 87% of hemodialysis patients and 18% of patients on con-servative treatment. Severe stage of disease comprises 28% of all 134 observed patients with secondary HPT. It is characterized with level of parathyroid hormone (PH) more than 600 pg/ml, serum calciumphosphorus product (CaхP) > 5,0 mmol2/l2, history of hemodialysis more than 3 years, bright clinical symptoms and significant lost of bone density. Positive results of 99mTc-MIBI scanning of parathyroids in combination with laboratory findings (high-normal or elevated serum calcium, PH > 800 pg/ml, CaхP >5,0 mmol2/l2), size of parathyroid gland >1 cm predict transformation to tertiary HPT with appearance of true adenomas (revealed in 64% of operated cases) and necessity of surgery. Other indications to surgery are severe bone turnover symptoms, calcification of soft tissues and vessels, intensive pruritus and bone pain. Evaluating of varioussurgical operations in 31 patients suggested subtotal parathyroidectomy as the preferable surgical procedure in management of secondary and tertiary HPT that can achieve fast recovering, lower the risk of permanent hypocalciemia and facilitate reoperation in case of possible relapse.