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European Archives of Oto-Rhino-Laryngology

, Volume 269, Issue 5, pp 1519–1525 | Cite as

Recurrence of secondary hyperparathyroidism in patients after total parathyroidectomy with autotransplantation: technical and therapeutic aspects

  • Ayman Agha
  • Martin Loss
  • Hans Jürgen Schlitt
  • Marcus N. Scherer
Head and Neck

Abstract

Recurrence of secondary hyperparathyroidism (rSHPT) in patients after total parathyroidectomy (TPTX) with autotransplantation (AT) represents a major diagnostic and therapeutic challenge. The aim of this retrospective cohort study was to evaluate rSHPT in patients after TPTX with AT and the subsequent surgical treatment. 112 patients with secondary hyperparathyroidism (surgery 1998–2008) were evaluated. In 16 patients, rSHPT was detected, while all of them had been originally operated with TPTX, cervical thymectomy and AT. The recurrence rate of TPTX with AT in our patient cohort was 14.2% (16/112). All the 16 patients with rSHPT suffered from forearm-autotransplant(s) hyperparathyroidism (AT-HPT). AT-HPT was diagnosed after a median of 5.6 years (1.5–11 years). All “forearm” AT-HPT operations were performed using the method of intra-operative parathyroid-hormone measurement. The histopathologic result showed hyperplasia or an adenoma of the reimplanted parathyroid gland (PTG) particles. The parathyroid hormone measurement (PTH) showed normal values in all cases 2 weeks after surgery. In none of the patients persistent hypocalcemia was observed. Our data demonstrates that the high rate of rSHPT in patients after TPTX with AT with renal-insufficiency represents an unsolved problem, often leading to re-operation including possible morbidity. Although we are not showing direct data, we propose, that the alternative method of TPTX without AT, simultaneous cryopreservation and potential metachronous reimplantation could offer an excellent alternative. However, this therapy option needs to be validated in further clinical trials.

Keywords

Secondary hyperparathyroidism Parathyroidectomy with autotransplantation Recurrence Autotransplant(s)-hyperparathyroidism Re-operation Possible metachronous autotransplantation 

Abbreviations

AT-HPT

Autotransplantion-hyperparathyroidism

rSHPT

Recurrence of secondary hyperparathyroidism

AT

Autotransplant

SHPT

Secondary hyperparathyroidism

PTG

Parathyroid gland

PTH

Parathyroid-hormone

SPTX

Subtotal parathyroidectomy

TPTX

Total parathyroidectomy with or without autotransplantation

iPTH

Intra-operative parathyroidhormone measurement

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Marx S, Spiegel AM, Skarulis MC et al (1998) Multiple endocrine neopasia type 1: clinical and genetic topics. Ann Intern Med 129:484–494PubMedGoogle Scholar
  2. 2.
    Valderrábano F, Berthoux FC, Jones EH et al (1996) Report on management of renal failure in Europe, XXV, 1994 end stage renal disease and dialysis report. The EDTA-ERA Registry. European Dialysis and Transplant Association. Nephrol Dial Transplant 11(Suppl 1):2–21PubMedGoogle Scholar
  3. 3.
    Alveryd A (1968) Parathyroid glands in thyroid surgery. Acta chir scand  389:1–120PubMedGoogle Scholar
  4. 4.
    Tominaga Y, Uchida K, Haba T et al (2001) More than 1000 cases of total parathyroidectmy with forearm autograft for renal hyperparathyroidism. Am J Kidney Dis 38:168–171CrossRefGoogle Scholar
  5. 5.
    Niederle B, Hörander H, Roka R et al (1989) Parathyreoidektomie und Autotransplantation beim renalen Hyperparathyreoidismus. I. Klinische und Laborchemische Untersuchungen zur Gewebeauswahl. Chirurg 60:665–670PubMedGoogle Scholar
  6. 6.
    Niederle B, Hörander H, Roka R et al (1989) Parathyreoidektomie und Autotransplantation beim renalen Hyperparathyreoidismus. I. Morphologische und funktionelle Untersuchung bei transplantat-abhängigem Rezidiv. Chirurg 60:671–677PubMedGoogle Scholar
  7. 7.
    Casanova D, Sarfati E, De Francisco A et al (1991) Secondary hypeparathyroidism: diagnosis of site of recurrence. World J Surg 15:546–550PubMedCrossRefGoogle Scholar
  8. 8.
    Schlosser K, Sitter H, Rotmund M et al (2004) Assessing the site of recurrence in patients with secondary hyperparthyoidism by simplified Casanova autograftectomy test. World J Surg 28:583–588PubMedCrossRefGoogle Scholar
  9. 9.
    Irvin GL, Deriso GT (1994) A new practical intraoperative parathyroid hormone assay. Am J Surg 168:466–471PubMedCrossRefGoogle Scholar
  10. 10.
    Rothmund M, Wagner PK, Schark C (1991) Subtotal parathyroidectomy versus total parathyroid-dectomy and autotransplantaion in secondary hyperparathyroidism: a randomized trial. World J Surg 15:745–750PubMedCrossRefGoogle Scholar
  11. 11.
    Agha A, Scherer MN, Mantouvalou K et al (2007) Effectiveness of parathyroid-hormone measurement in detecting patients with multiple gland disease causing primary hyperparathyroidism. Langenbecks Arch Surg. 392(6):703–708PubMedCrossRefGoogle Scholar
  12. 12.
    Frei U, Klempa I, Schneider M, Scheuermann EH, Koch KM (1981) Tumour-like growth of parathyroid autografts in uraemic patients. Proc Eur Dial Transplant Assoc 18:548PubMedGoogle Scholar
  13. 13.
    Zou Q, Wang HY, Zhou J, Lao ZY, Xue J, Li MX, Li HM, Jin YT, Gu Y, Zhang Yli (2007) Total parathyroidectomy combined with partial autotransplantation for the treatment of secondary hyperparathyroidism. Chin Med J 120(20):1777–1782PubMedGoogle Scholar
  14. 14.
    Jofre R, Lopez Gomez JM, Menarguez J, Polo JR, Guinsburg M, Villaverde T et al (2003) Parathroidectomy: whom and when? Kidney Int Suppl 85:S97–S100PubMedCrossRefGoogle Scholar
  15. 15.
    Peeler BB, Martin WH, Sandler MP et al (1997) Sestamibi parathyroid scanning and pre-operative studies for patients with recurrent/persistent hyperparathyroidism or significant comorbid conditions: development of an optimal localization strategy. Am Surgeon 63:37–46PubMedGoogle Scholar
  16. 16.
    Skinner KA, Zuckerbraun L (1996) Recurrent secondary hyperparathyroidism. An argument for total parathyoridectomy. Arch Surg 131:724–727PubMedCrossRefGoogle Scholar
  17. 17.
    Rothmund M (1980) Operative Behandlung des sekundären hypeparathyreoidismus. In: Rothmund M (Hrsg) Hyperparathyreoidismus, 1st edn. Thieme, Stuttgart, S234–S246 Google Scholar
  18. 18.
    Majors JD, Burke GJ, Mansberger AR Jr et al (1995) Technetium Tc-99 m sestamibi scan for localization abnormal parathyroid glands after previous neck operation: preliminary experience in reoperative cases. South Med J 88:327–330PubMedCrossRefGoogle Scholar
  19. 19.
    Brennan MF, Brown EM, Spiegel AM et al (1979) Autotransplantation of cryopreserved parathyroid tissue in man. Ann Surg 189(2):139–142PubMedCrossRefGoogle Scholar
  20. 20.
    Cohen MS (2005) Long-term functionality of cryopreserved parathyroid autografts: a 13-year prospective analysis. Surgery 138(6):1033–1040PubMedCrossRefGoogle Scholar
  21. 21.
    Wells SA Jr, Gunnells JC, Gutman RA et al (1977) The successful transplantation of frozen parathyroid tissue in man. Surgery 81(1):86–90PubMedGoogle Scholar
  22. 22.
    Wells SA Jr, Christiansen C (1974) The transplanted parathyroid gland: evaluation of cryopreservation and other environmental factors which affect its function. Surgery 75(1):49–55PubMedGoogle Scholar
  23. 23.
    Saxe AW, Spiegel AM, Marx SJ et al (1982) Deferred parathyroid autografts with cryopreserved tissue after re-operative parathyroid surgery. Arch Surg 117(5):538–543PubMedCrossRefGoogle Scholar
  24. 24.
    Wells SA Jr, Farndon JR, Dale JK et al (1980) Long-term evaluation of patients with primary parathyroid hyperplasia managed by total parathyroidectomy and heterotopic autotransplantation. Ann Surg 192(4):451–458PubMedCrossRefGoogle Scholar
  25. 25.
    Wagner PK, Rumpelt HJ, Krause U et al (1986) The effect of kryopreservation on hormone secretion in vitro and morphology of human parathyroid tissue. Surgery 99(3):257–264PubMedGoogle Scholar
  26. 26.
    de Menezes Montenegro FL, Custódio MR, Arap SS et al (2007) Successful implant of long-term cryopreserved parathyroid glands after total parathyroidectomy. Head Neck 29(3):296–300PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ayman Agha
    • 1
  • Martin Loss
    • 1
  • Hans Jürgen Schlitt
    • 1
  • Marcus N. Scherer
    • 1
  1. 1.Department of SurgeryUniversity Hospital RegensburgRegensburgGermany

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