RECURRENT SECONDARY HYPERPARATHYROIDISM - AN ARGUMENT FOR TOTAL PARATHYROIDECTOMY

Objective: To define better the incidence and causes of recurrent seco ndary hyperparathyroidism. Design: Review of total parathyroidectomy w ith auto-transplantation in uremic patients and literature review. Set ting: Two teaching hospitals. Patients: Nine patients treated for seco ndary hyper-parathyroidism between 1982 and 1993 by a single surgeon. Interventions: Total parathyroidectomy with auto-transplantation into the sternocleidomastoid muscle. Recurrence was treated, if necessary, with a graft reduction procedure. Main Outcome Measures: The symptomat ic and biochemical response to initial therapy, morbidity, and mortali ty, as well as the development of recurrent hypercalcemia. Results: Al l patients were normocalcemic after their initial surgery. One patient died postoperatively (mortality, 11%). Three (38%) of the remaining p atients developed recurrent hypercalcemia, 2 (25%) requiring reoperati on. Of the 2 patients who underwent surgery for recurrence, 1 had an a denoma in the implant and the other had graft hyperplasia. Conclusions : Recurrence rates after total parathyroidectomy with autotransplantat ion are substantial and, given the pathophysiology of secondary hyperp arathyroidism, unavoidable in patients with uncorrected renal failure. An argument is made for performing total parathyroidectomy alone in p atients with secondary hyperparathyroidism who will not undergo renal transplantation in the near future.