OPERATIVE THERAPY OF RENAL HYPERPARATHYRO IDISM - A PROSPECTIVE FOLLOW-UP-STUDY

A prospective long-term follow-up study in patients who had had surgic al therapy for renal hyperparathyroidism was launched to investigate t he results of surgical treatment and to evaluate possible correlations between preoperative laboratory values and the course of the symptoms . From August 1987 to December 1995, 79 patients underwent surgery for renal hyperparathyroidism. It was the first neck exploration for 72 p atients. Total parathyroidectomy with autotransplantation to a forearm was our preferred procedure (n = 67). The postoperative course of all patients is known. We carried out one to nine reexaminations (median 4) in 74 of 79 patients. The follow-up period ranged from 1 month to 5 years with a median of 18 months. After the operation transient hypoc alcaemia occurred in 84.8% of patients. Postoperative hypocalcaemia co rrelated negatively with the preoperative levels of alkaline phosphata se and intact parathyroid hormone. Within the first month after surger y 60% of the preoperatively affected patients completely recovered fro m pruritus, whereas the skeletal syndrome took longer to disappear. On e year after surgery 75% of the patients with pruritus and 79% of thos e with skeletal syndrome had became asymptomatic. After total parathyr oidectomy with autotransplantation, patients with preoperatively eleva ted concentrations of alkaline phosphatase ( > 200 U/l) experienced fa ster relief from joint pain than patients with preoperatively normal c oncentrations (P = 0.0297). To date 4.5% of the patients developed rec urrent hyperparathyroidism after total parathyroidectomy with autotran splantation. Morbidity of surgery for renal hyperparathyroidism is inf luenced by patients' risk factors. Postoperative hypocalcaemia correla tes negatively with the grade of renal osteopathy at the time of opera tion. Preoperative concentrations of alkaline phosphatase influence th e rapidity of the relief from joint pain.