PARATHYROIDECTOMY IN THE TREATMENT OF SECONDARY HYPERPARATHYROIDISM IN CHRONIC-RENAL-FAILURE

During the period 1983-1995, 200 chronic renal failure patients (115 m ales and 85 females) were parathyroidectomized for hyperparathyroidism in our Department. In all of them, the presenting clinical symptoms, physical signs, biochemical and radiological tests were typically thos e of hyperparathyroidism, One hundred ninety patients were operated fo r the first time whereas 10 were re-operated due to relapse of the dis ease; 3 of these cases were primary hyperparathyroidism, 182 secondary and 5 tertiary, All three primary hyperparathyroidism cases underwent removal of the adenoma; in the group of secondary hyperparathyroidism , 50 underwent removal of all the parathyroid glands found, 25 underwe nt total parathyroidectomy with forearm or deltoid autograft and 60 su btotal parathyroidectomy whereas in 39 and 8 patients only 3 and 2 par athyroid glands were found respectively, In the group of tertiary hype rparathyroidism, we removed only the hyperplastic gland detected as th e operative detection of the rest was not possible, Ten cases were re- operated for removal of the remaining glands, Na complications were no ted postoperatively, apart from severe hypocalcemia in 20 cases, treat ed successfully by Calcium and Vitamin D administration, The highest r elapse rate was noted among the 8 patients with only the 2 parathyroid glands removed. It seems that total or subtotal parathyroidectomy rep resents the most successful methods for surgical treatment of hyperpar athyroidism complicating chronic renal failure.