Calciphylaxis: Is there a role for parathyroidectomy?

Objective: Calciphylaxis, a rare disorder typically affecting renal failure patients, results in vascular calcification with subsequent skin necrosis, gangrene, and often death from sepsis, Parathyroid hormone is thought to a ct as a tissue sensitizer leading to these soft tissue changes. As such, pa rathyroidectomy is often advocated to control this complicated condition. A discussion of calciphylaxis does not exist in the otolaryngology literatur e, and head and neck surgeons performing parathyroidectomy should be aware of this phenomenon. This study evaluates the success of parathyroidectomy i n reversing the ill effects of calciphylaxis in both our patient population and the literature. Study Design: Retrospective study and review of the Li terature. Methods: Five patients with calciphylaxis treated at our institut ion were evaluated for mortality, surgical and perioperative complications, wound healing, and predictors of patient outcomes. Results: Two patients d ied from sepsis and infectious complications of their calciphylaxis shortly after surgery. Of the three survivors, tno later died (15 and 18 mo after surgery) from causes not directly related to calciphylaxis, The other long- term survivor required partial amputation of a leg for osteomyelitis, There was one operative complication-a wound infection requiring antibiotic ther apy, drainage, and packing, Postoperative hypocalcemia required treatment i n two patients. Immediate perioperative survival was more likely in patient s with leukocyte counts less than 20,000 cells/mL, Conclusions: Calciphylax is is a serious disease and patients often succumb to sepsis and infectious complications, Patients with extremely high leukocyte counts from coexiste nt infections may have a worse prognosis, Although a conclusive effective t herapy does not exist, parathyroidectomy can be safely performed and may be nefit some patients with what is often an otherwise fatal disease. The Lite rature to date generally confirms our findings.