[The effect of conservative and surgical management for secondary hyperparathyroidism and their problems].
We compared the effect of conservative treatment with that of surgical treatment after applying them on secondary hyperparathyroidism patients (2nd HPT) in order to study the application of surgery on 2nd HPT patients. We selected the test subject of 39 maintenance dialysis patients with complications of 2nd HPT. The conservative treatments were; elcitonine administration (40 u x 3/W) (group 1), ipriflavon administration (200 mg x 3/day) (group 2), and pulse treatment (1.25 (OH)2D3 6 micrograms/W) (group 3). For surgical treatment, we adopted total parathyroidectomy with auto-transplantation into the arm (PTX). The transition of serum parathyroid hormone (PTH-C), alkali-phosphatase (ALP), bone scintigraphy of every 6 months, and change of bone mineral content (BMC) were compared to judge the effects of treatments. We measured 1/3, 1/6 radial region with single photon absorptiometry (SPA) and L3 region with dual photon absorptiometry (DPA) to obtain BMC. We were forced to transfer the patients in groups 1 and 2 (conservative treatment) to pulse treatment or PTX as 12 months later they showed increase in serum PTH-C, ALP and significant drop (P less than 0.05) in BMC average change rate (1/3). In group 3 of pulse treatment, though significant decrease in serum ALP (P less than 0.01) was detected for 10 cases out of 12, serum PTH-C was either unchanged or increased for 4 cases with the value of more than 30 ng/ml. Furthermore the average change rate of BMC stayed at the same level.(ABSTRACT TRUNCATED AT 250 WORDS)
Sugimura
T
T
Department of Urology, School of Medicine, Osaka City University.
Yamagami
S
S
D015650:24,25-Dihydroxyvitamin D 3 / Q000627:therapeutic use; D000328:Adult; D001132:Arm; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002116:Calcitonin / Q000031:analogs & derivatives / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D007529:Isoflavones / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic
D007529:Isoflavones; D015650:24,25-Dihydroxyvitamin D 3; C018986:ipriflavone; D002116:Calcitonin; C012755:elcatonin