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Effect of calcium supplementation on severe hypocalcemia in patients with secondary hyperparathyroidism after total parathyroidectomy

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World Journal of Clinical Cases 2022年第13期10卷 4033-4041页

作者： Jun Liu Xue-Feng Fan Meng Yang Lin-Ping Huang Ling Zhang Department of General Surgery China-Japan Friendship HospitalBeijing 100029China Department of General Surgery Shougang General HospitalShougang 553000Guizhou ProvinceChina Department of Nephrology China-Japan Friendship HospitalBeijing 100029China

BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without *** To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH occurrence after *** This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship *** January 2015 to May 2016,conventional CS was performed in patients who underwent TPTX,with calcium amounts adjusted according to postoperative serum calcium *** October 2016 to May 2018,preventive CS was performed according to preoperative alkaline phosphatase(ALP)*** patients were defined as lowrisk(ALP500 U/L)for *** preoperative blood samples were collected in the fasting state on the day before *** blood samples were obtained at 6-7 AM from the first postoperative *** A total of 271 patients were *** patients were 47.7±11.1 years old,and 57.6%were *** mean body mass index(BMI)was 22.9±3.8 kg/m^(2).There were no significant differences in sex,age,BMI,preoperative ALP,serum calcium,serum phosphorus,calcium-phosphorus ratio,and intact parathyroid hormone(iPTH)between the two CS *** with conventional CS,preventive CS led to lower occurrence rates of hypocalcemia within 48 h(46.0%vs 74.5%,P<0.001)and SH(31.7%vs 64.1%,P<0.001).Multivariable analysis showed that preoperative iPTH levelsodds ratio(OR)=1.001,95%confidence interval(CI:1.000-1.001,P=0.009),preoperative ALP amounts(OR=1.002,95%CI:1.001-1.003,P=0.002),preoperative serum phosphorus levels(OR=8.729,95%CI:1.518-50.216,P=0.015)and preventive CS(OR=0.132,95%CI:0.067-0.261,P<0.001)were independently associated with *** patients with preoperative ALP≥500 U/L,only preventive CS(OR=0.147,95%CI:0.038-0.562.P=0.005)was independently associated with *** This study suggests that preventive CS could reduce the occurrence of SH,indica

关键词： End-stage renal disease secondary hyperparathyroidism Parathyroidectomy Hypocalcemia Calcium supplementation

Radioactive probe-guided parathyroidectomy for secondary hyperparathyroidism

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Chinese Medical Journal 2014年第13期127卷 2413-2418页

作者： Yuan Fei Yu Weijia Waqas Ahmad Yang Zhixue Cao Hua Li Juncheng Jiang Guoqin Department of General Surgery the Second Affiliated Hospital ofSoochow University Suzhou Jiangsu 215004 China

Background The value of gamma probes in the surgical treatment of secondary hyperparathyroidism （sHPT） was *** aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe *** We retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September *** 99Tcm-methoxyisobutyl isonitrile （MIBI） scintigraphy and high-frequency ultrasonography were used for parathyroid ***-five patients （group Ⅰ） underwent conventional neck exploration and open *** patients （group Ⅱ） underwent gamma probe-guided total parathyroidectomy and parathyroid *** two groups were compared in terms of the number of parathyroid resections,operative time,and postoperative changes in the blood levels of parathyroid hormone （PTH）,calcium,and *** The clinical manifestations,PTH and calcium levels,age distribution,and clinical characteristics did not differ between the two *** accuracy of preoperative 99Tcm-MIBI scintigraphy （89.74％） for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography （81.25％）.However,the accuracy of 99TcmMIBI scintigraphy （66.67％） for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography （76.86％）.The operation time was significantly longer in group Ⅰ （（120±25） minutes） than in group Ⅱ （（90±30） minutes）.The accuracy of parathyroid identification was significantly higher in group Ⅱ （92.59％） than in group Ⅰ （80.39％）.On average,significantly fewer parathyroid specimens were obtained in group Ⅰ （2.5±0.5） than in group Ⅱ （3.5±0.5）.Compared with group Ⅰ,group Ⅱ showed a significant increase （15.4％） in the number of parathyroid *** PTH,calcium,and phosphate levels significantly decreased postoperatively in all *** Intraoperative gamma probe examination confirmed that the excised s

关键词： secondary hyperparathyroidism hyperthyroidism 99Tcm-MIBI imaging gamma probe

Paricalcitol in hemodialysis patients with secondary hyperparathyroidism and its potential benefits

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World Journal of Clinical Cases 2021年第33期9卷 10172-10179页

作者： Xiu Chen Feng Zhao Wei-Juan Pan Jia-Mei Di Wei-Nan Xie Ling Yuan Zhi Liu Department of Nephrology The First Affiliated Hospital of Anhui University of Science and Technology(The First People’s Hospital of Huainan)Huainan 232007Anhui ProvinceChina

BACKGROUND secondary hyperparathyroidism(SHPT)is a common complication in patients with end-stage renal disease and it is also common in hemodialysis *** can increase bone fragility and calcification of blood vessels and soft tissues,which greatly increases the risk of *** To discuss the outcome,safety and other potential benefits of paricalcitol injection in hemodialysis patients with *** We recruited 40 patients who received hemodialysis at our hospital for chronic renal failure with SHPT between March and December *** received paricalcitol injection for 24 wk(starting dose,0.06–0.08μg/kg),three times per *** were followed up at the baseline(week 0),week 4,week 12 and week *** primary outcome indicator was the percentage of patients with a>30%decrease in intact parathyroid hormone(iPTH)levels at week 24 compared with the *** secondary outcome indicators included percentage decrease in iPTH levels at week 24,standard-reaching rate of iPTH(percentage of patients with iPTH down to 130–585 pg/mL),changes in serum levels of calcium(Ca),phosphate(P),Ca×P product,alkaline phosphatase(ALP),creatinine(Cre),hemoglobin(Hb),and C-reactive protein(CRP),and incidence of adverse events(AEs).RESULTS After 24 wk of treatment,iPTH levels decreased significantly(598.88±381.29 pg/mL vs 888.84±376.88 pg/mL,P0.05).After 24 wk of treatment,serum P levels decreased compared with the baseline(1.91±0.40 mmol/L vs 2.16±0.66 mmol/L)(t=2.830,P<0.05).Ca×P product decreased significantly compared with the baseline(56.38±13.22 mg2/dL

关键词： Paricalcitol Hemodialysis secondary hyperparathyroidism Drug efficacy Drug safety

Thyrotoxicosis Occurring in secondary hyperparathyroidism Patients Undergoing Dialysis after Total Parathyroidectomy with Autotransplantation

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Chinese Medical Journal 2017年第16期130卷 1995-1996页

作者： Zhou Xu Yu-Tuan Wu Xin Li He Wu Hao-Ran Chen Yan-Ling Shi Bilal Arshad Hong-Yuan Li Kai-Nan Wu Ling-Quart Kong Department of Endocrine and Breast Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing 400016 China

secondary hyperparathyroidism （SHPT） is a common complication in chronic kidney disease （CKD） that is characterized by excessive synthesis of parathyroid hormone （PTH） and parathyroid *** prevalence of CKD is estimated to be 5-10%, and the burden of CKD-associated diseases is alarmingly *** advances in medical therapy for SHPT, surgical parathyroidectomy remains the definitive therapy for refractory SHPT, which drastically decreases PTH levels and ameliorates symptoms related to severe SHPT.

关键词： Autotransplantation: Dialysis Parathyroidectomy secondary hyperparathyroidism Thyrotoxicosis

Bone Dysmorphia-Induced Blindness Following a secondary hyperparathyroidism: A Case Report

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Open Journal of Nephrology 2021年第4期11卷 489-494页

作者： Gael Honal Mahoungou Daniel Tony Eyeni Sinomono Ghislain Armel Mpandzou Regis Franck Moyikoua Josue Euberma Diatewa Dinah Happhia Motoula Benedicte Diatewa Helena Botokoto Bothard Richard Loumingou Faculty of Health Sciences of Brazzaville Marien Ngouabi University Brazzaville Republic of Congo Department of Nephrology University Hospital of Brazzaville Brazzaville Republic of Congo

Introduction: Conjunctival-corneal or choroidal calcifications are frequent in SHPT, blindness is however exceptional. We report a case of blindness secondary to compressive ischemic optic neuropathy. Case Report: Mr. B.E.K., 49 years old, has a chronic renal failure secondary to unlabeled glomerular nephropathy for 17 years. He has been on chronic hemodialysis for 12 years and has had SHPT for nine years. He secondarily developed disabling segmental osteoarticular deformities associated with kyphoscoliosis, “drumstick” fingers and facial dysmorphism. Five months before admission he developed eye pain and reduced visual acuity progressing within one month to blindness. Biology noted: serum creatinine at 726 umol/l (60 - 120 umol/L), azotemia at 14.3 mmol/l (2.5 - 7.5 mmol/L), serum calcium at 2.25 (2.25 - 2.55 mmol/L), phosphatemia at 1.13 (0.8 - 1.35 mmol/L), alkaline phosphatases at 2196 (5 - 270 IU/L) and parathyroid hormone level at 2257 (10 - 60 pg/mL). Retinal angiography revealed lesions suggestive of ischemic neuropathy. The orbit CT scan with 3D coronal reconstruction revealed narrowing of the caliber of the optical channels with dystrophic thickening of the skull base and cranial vault. Cranioencephalic and orbital MRI revealed diffuse brown tumors and pre-chiasmatic optic atrophy. Discussion: The most frequent ocular complications of SHPT are conjunctival-corneal or sclero-choroidal calcifications, asymptomatic, associated with hypercalcemia. Compressive manifestations are rarer, represented mainly by an amputation of the visual field, diplopia, ptosis or blindness, as described in our patient. The main cause is osteodystrophy and brown tumors of the skull base (1% - 2%). Conclusion: This case report underlines the importance of early detection of SHPT, in order to avoid its major complications, such as blindness, especially since current preventive and curative measures have proven their

关键词： Blindness secondary hyperparathyroidism Bone Dysmorphism

Harmonic focus versus classic Haemostasis in total parathyroidectomy for secondary hyperparathyroidism

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Harmonic focus versus classic Haemostasis in total parathyro...

Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy:A case report

2014第六届全国甲状腺肿瘤学术大会

作者： Qingqing He Dayong Zhuang Luming Zheng Ziyi Fan Jian Zhu Peng Zhou Fang Yu Lei Hou Yanning Li Yanming Ge

Purpose The aim of this prospective study was to compare operative factors, postoperative outcomes and surgical complications of open total parathyroidectomy between the Harmonic Focus（Focus group） and the classic haemostasis（classic group）. Methods Fifty-six patients with secondary hyperparathyroidism underwent open total parathyroidectomy were randomized into two groups: the Focus group and the classic group. We recorded these following data: age, sex, haemostatic technique, operative time, drainage volume, length of incision, postoperative incision pain, postoperative complications, and hospital stay. Results No significant difference was found between the two groups concerning postoperative serum PTH and mean hospital stay（P＞0.05）. But the mean operation time and the length of incision were significantly shorter and the total drainage fluid volume was lower in Focus group（P＜ 0.05）. The Focus group experienced significantly less postoperative incision pain at 24 and 48 hours（P＜ 0.05）.One transient recurrent laryngeal nerve palsy was observed in the classic group and no one in the Focus group. After operation, pruritus, the bone pain and muscle weakness disappeared, and serum PTH and serum phosphate were declined markedly. Conclusions In patients undergoing total parathyroidectomy, Harmonic Focus may be a reliable and safe alternative.

关键词： secondary hyperparathyroidism Harmonic Focus Parathyroid Haemostasis Total Parathyroidectomy

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World Journal of Clinical Cases 2024年第7期12卷 1313-1319页

作者： Shan-Shan Xu Li-Hai Hao Yan-Meng Guan Hemodialysis Center Weifang People’s HospitalWeifang 261041Shandong ProvinceChina

BACKGROUND Refractory secondary hyperparathyroidism(SHPT)is a common complication observed in patients with end-stage renal disease and can result in ectopic *** calcification involving the heart valves and the conduction system can easily lead to arrhythmias,including atrioventricular *** case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block(CAVB),which was eventually reversed to a first-degree atrioventricular *** SUMMARY We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus *** developed SHPT,and an electrocardiogram revealed a first-degree atrioventricular ***,she underwent parathyroidectomy(PTX)with ***,a few years later,she developed SHPT again,and an electrocardiogram revealed a CAVB.A few years after the second PTX surgery,the calcification of the left atrium and left ventricle improved,and her CAVB was *** This case revealed that metastatic cardiac calcification can result in complete atrioventricular *** parathyroid surgery,calcification of the cardiac conduction system improved,leading to reversal of the atrioventricular *** is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.

关键词： secondary hyperparathyroidism Ectopic calcification Atrioventricular block Reversal Case report

Parathyroidectomy restored bone mineral density in a neglected femoral neck fracture with renal osteodystrophy:A case report

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World Journal of Clinical Cases 2024年第25期12卷 5761-5768页

作者： Tzu-Ching Lin Shih-Wei Lin Kuang-Ting Yeh Department of Education Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationHualien 970473Taiwan ProvinceChina Department of Orthopedics Ten-Chan Medical GroupTaoyuan 320003Taiwan ProvinceChina Department of Orthopedics Hualien Tzu Chi HospitalBuddhist Tzu Chi Medical FoundationHualien 970473Taiwan ProvinceChina Department of Graduate Institute of Clinical Pharmacy Tzu Chi UniversityHualien 970374Taiwan ProvinceChina

BACKGROUND This case report contributes to the medical literature by highlighting the successful management of a neglected femoral neck fracture in a patient with renal osteodystrophy and secondary hyperparathyroidism(SHPTH)who was on dialysis due to end-stage renal disease(ESRD).It underscores the efficacy of parathyroidectomy(PTX)in restoring bone mineral density(BMD)and promoting fracture healing,addressing a significant complication in ESRD *** SUMMARY A 36-year-old female with renal osteodystrophy and on dialysis due to ESRD presented with a history of left patellar tendon rupture and later,a right achilles tendon avulsion *** right hip pain led to the discovery of a neglected right femoral neck fracture,which was initially overlooked due to the patient’s complex medical *** months post-achilles tendon repair,the patient underwent PTX to manage the refractory *** postoperative course included rehabilitation and weight-bearing ***,2 years after osteosynthesis,radiographic assessments indicated a solid union of the periprothesis fracture and significant improvement in BMD,showcasing the efficacy of the treatment *** PTX,combined with appropriate rehabilitation,is crucial for improving BMD and fracture healing in ESRD patients with SHPTH.

关键词： secondary hyperparathyroidism Parathyroidectomy Fracture Renal osteodystrophy Case report

Surgical Treatment of hyperparathyroidism secondary to Chronic Renal Failure: Our Experience with the 7/8 Subtotal Parathyroidectomy Technique

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International Journal of Otolaryngology and Head & Neck Surgery 2022年第1期11卷 25-30页

作者： Ahmadou C. Sall Mame S. Diouf Houra Ahmed Ngor Ndour Ciré Ndiaye Abdou Sy Richard E. A. Deguenonvo Evelyne S. Diom Malick Ndiaye Abdourahmane Tall Bay K. Diallo Issa C. Ndiaye Raymond Diouf ENT Department Fann National University Hospital Dakar Senegal ENT and Cervico-Facial Surgery General Hospital Idrissa Pouye de Grand-Yoff Dakar S&#233 né gal ENT Department Diamniadio Children Hospital Dakar Senegal ENT Department Peace Hospital of Ziguinchor Ziguinchor Senegal ENT Department Albert Royer Children Hospital Dakar Senegal

Introduction: Surgical management takes place, after a certain period of evolution, on particularly severe forms of secondary hyperparathyroidism, resistant to medical treatment. Subtotal parathyroidectomy is an effective technique in the treatment of these disorders. Method: Our study is retrospective of 33 cases of hyperparathyroidism secondary to chronic renal failure in dialysis patients operated by the 7/8 technique. Identified over a period of 10 years (January 2010 to December 2019), in the ENT department of the Fann University Hospital. Results: Out of 33 cases of secondary hyperparathyroidism, the average age of our patients was 51.24 years with a sex ratio of 0.43. Causal nephropathy was dominated by nephro-angiosclerosis, which was found in 27.27% of cases. Bone pain found in 23 patients or 69.69% was the predominant clinical sign. The average calcemia was 92.7 mg/l. Parathormone was dosed in all our patients and the average was 1611.05 ng/l. The consequences were clinically marked by recurrent paresis in one patient. No case of hematoma or postoperative infection was found. On the biological level 10 patients or 30.30% had a transient hypocalcaemia. The results were marked by a drop in PTH in 23 patients or 78.78% of cases. Conclusion: Subtotal parathyroidectomy remains an effective and beneficial therapeutic method for kidney failure patients with secondary hyperparathyroidism.

关键词： secondary hyperparathyroidism 7/8 Parathyroidectomy Transient Hypocalcemia Persistent hyperparathyroidism