Parathyroidectomy promotes wound healing and prolongs survival in patientswith calciphylaxis from secondary hyperparathyroidism

Background. Calciphylaxis is a rare but life-threatening condition occasion ally affecting Patients with secondary hyperparathyroidism. Parathyroidecto my has been advocated as the only potentially curative intervention. Methods. Between January 1989 and May 2000, 13 patients with pathologic/cli nical criteria of calciphylaxis were treated at our institution. Of these 1 3 patients, 7 were managed with medical therapy alone, and 6 were referred for parathyroidectomy. The medical records were reviewed, and patients/rela tives were interviewed. Results. All Patients had cutaneous wounds requiring local debridement pred ominantly located on the lower extremities or abdominal wall. Six patients underwent subtotal (3.5 gland) parathyroidectomy without morbidity. All 6 h ad significant reductions in parathyroid hormone levels after surgery (mean decrease, 94% +/- 0%), and all reported resolution of pain and healing of cutaneous wounds. Of the remaining 7 patients who had medical management al one, 5 eventually died of complications related to calciphylaxis. In compar ing the 2 groups, patients who underwent parathyroidectomy had a significan tly longer median survival than those who did not have surgery (36 vs 3 mon ths, P = .021). Conclusions. Calciphylaxis frequently causes gangrene, sepsis, and eventual death. Parathyroidectomy can be performed with minimal morbidity and is as sociated with resolution of pain, wound healing, and a significantly longer median survival. Therefore, Patients with secondary hyperparathyroidism an d signs/symptoms of calciphylaxis should be referred promptly for considera tion of parathyroidectomy.