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Manuel C. Martins de Castro, Vanda Jorgetti, Assessment of parathyroid hormone secretion before and after total parathyroidectomy with autotransplantation, Nephrology Dialysis Transplantation, Volume 14, Issue 9, September 1999, Pages 2264–2265, https://doi.org/10.1093/ndt/14.9.2264
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Sir,
Secondary hyperparathyroidism is a frequent complication of chronic renal failure. Prophylaxis using dietary phosphate restriction, oral phosphate binders and calcitriol are the first step to clinical approach. Unfortunately, both appropriate control of hyperphosphataemia and calcitriol therapy frequently fail to control hyperparathyroidism, and parathyroidectomy is required for these patients.
Parathyroidectomy can be partial or total, with or without parathyroid fragment implant in the forearm. Several studies assessed the outcomes after each of these treatment modalities [1–4]. In patients with parathyroid fragment grafts in the forearm, functional assessment was limited to comparison of parathyroid hormone (PTH) concentrations in both arms [5–8].
As far as we know, there are no studies to assess the parathyroid graft function by analysis relating PTH secretion with serum calcium concentration after induction of hypo- and hypercalcaemia. We have studied parathyroid function using this approach in a patient with hyperparathyroidism before and after total parathyroidectomy with heterotopic autotransplantation. This patient was a female aged 47 years undergoing haemodialysis for 115 months. Before total parathyroidectomy, intact PTH was 1031 pg/l (range 8–76), alkaline phosphatase 960 U/l (range 32–104), and total serum calcium 2.15 mmol/l. The X-ray of bones, scintigraphy with technetium and the bone biopsy showed hyperparathyroidism. The patient underwent parathyroidectomy. Four glands were removed with the following dimensions: upper-right 1.9×0.7×0.3 cm; upper-left 2.0×0.9×0.5 cm; lower-right 1.3×0.8×0.5 cm, and lower-left 2.0×0.9×0.5 cm. Twenty fragments of 1 mm were implanted under the brachioradial muscle in the arm contralateral to the arterious-venous fistulae. Fifteen and forty-five days after the surgery, intact PTH was 13.0 and 13.4 pg/l, alkaline phosphatase 1291 and 587 U/l, and serum calcium 2.05 and 2.1 mmol/l respectively. The histological examination shows parathyroid hyperplasia.
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