Refractory renal hyperparathyroidism: Clinical features and outcome of surgical therapy

Despite improvements in medical management parathyroidectomy has an importa nt role in treatment of refractory renal hyperparathyroidism (HPT). The med ical records of all patients who underwent parathyroidectomy from 1991 thro ugh 2000 were reviewed to determine the clinical and laboratory features an d outcomes of treatment in patients with renal versus primary HPT. Twenty-o ne of 92 patients who underwent parathyroidectomy had renal HPT with a mean age of 47 +/- 3 years compared with 56 +/- 2 years for patients with prima ry HPT (P < 0.05). Clinical manifestations included osteodystrophy (19), pr uritus (six), extraosseous calcification (three), and calciphylaxis tone). Parathyroid hormone, phosphorus, and alkaline phosphatase levels and weight s of excised glands were higher in renal versus primary HPT (P < 0.05). Sup ernumerary glands were found in three patients (14%) with renal HPT and non e of nine patients with primary parathyroid hyperplasia, After surgical the rapy persistent or recurrent HPT occurred in three (14%) patients with rena l and one (1.4%) patient with primary HPT (P < 0.05), Postoperative hypocal cemia occurred in 20 (95%) patients with renal HPT all of whom required int ravenous calcium, compared with 25 (35%) patients with primary HPT (P < 0.0 5) of whom only three (4%) required intravenous calcium (P < 0.05). In cont rast to those with primary HPT patients with renal HPT are younger and more likely to have severe osteodystrophy, postoperative hypocalcemia, and pers istent or recurrent HPT.