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Parathyroidectomy for Renal Hyperparathyroidism in Children and Adolescents

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Abstract

Background

Renal hyperparathyroidism (rHPT) almost inevitably develops in pediatric patients with end-stage chronic kidney disease (CKD) and may require parathyroidectomy (PTX) despite intensified conservative therapy. Long-term duration of uncontrolled rHPT may result in disabling osteodystrophy and vascular calcifications. Only a few reports on children undergoing PTX for rHPT are available and mainly consist of case reports with short follow-up periods. To study this entity, we analyzed the course of 23 pediatic patients who underwent PTX for rHPT.

Methods

Twenty-three patients with a mean age of 15 years and who underwent PTX for rHPT between 1986 and 2006 were evaluated. Surgical indications and techniques, specific postoperative management, and follow-up courses are described.

Results

Preoperative mean serum (s-) calcium was 2.7 ± 0.05 mmol/L (normal range = 2.2–2.7 mmol/L); s-phosphate was 1.8 ± 0.1 mmol/L (normal range = 0.8–1.6 mmol/L), and mean intact parathyroid hormone (PTH) level was 1240.1 ± 160.1 pg/ml (normal range = 11–65 pg/ml). Twenty-one patients underwent initial PTX and two patients underwent reoperative PTX. Total PTX with parathyroid autotransplantation (AT) was performed in 18 patients. In three patients less than four parathyroid glands were identified and no AT was performed consecutively. Postoperatively, no complications with respect to bleeding or vocal cord damage were recorded. The postoperative values of s-calcium, s-phosphate, and PTH decreased to or below normal range (s-calcium = 2.0 ± 0.1 mmol/L, s-phosphate = 1.2 ± 0.1 mmol/L, PTH = 50.1 ± 11.2 pg/ml). All 15 children below the age of 15 years required calcium intravenously. Follow-up was obtained in all patients 69.6 ± 11.4 months after PTX. Bone pain resolved in all previously symptomatic patients. S-calcium was 2.2 ± 0.2 mmol/L, s-phosphate was 1.4 ± 0.3 mmol/L, and PTH was 90.2 ± 21.5 pg/ml. No patient required repeated parathyroid autografting, and only one underwent an explantation of his AT six years after initial PTX.

Conclusion

Total PTX with AT in pediatric patients with rHPT is a safe and effective procedure. It should be considered if rHPT is refractory to conservative treatment, in view of the risk of potentially lethal vascular calcifications developing in the majority of adults with childhood onset of CKD.

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Authors and Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, Philipps-University, Baldingerstrasse, 35033, Marburg, Germany

    Katja Schlosser, Johanna E. Bartholomaeus & Matthias Rothmund

  2. Division of Paediatric Nephrology, University Hospital for Paediatric and Adolescent Medicine, University of Heidelberg, Im Neuenheimer Feld 153, 69120, Heidelberg, Germany

    Claus P. Schmitt

  3. Department of Surgery, University Hospital Mannheim, Faculty for Clinical Medicine, Ruprechts-Karls-University, Heidelberg, Germany

    Katrin L. Suchan

  4. Department of Surgery, University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Buchler & Theresia Weber

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  1. Katja Schlosser
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  2. Claus P. Schmitt
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  3. Johanna E. Bartholomaeus
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Correspondence to Katja Schlosser.

Additional information

K. Schlosser and C. P. Schmitt contributed equally to this work.

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Schlosser, K., Schmitt, C.P., Bartholomaeus, J.E. et al. Parathyroidectomy for Renal Hyperparathyroidism in Children and Adolescents. World J Surg 32, 801–806 (2008). https://doi.org/10.1007/s00268-007-9318-6

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