title: Operative treatment of renal autonomous hyperparathyroidism: cause of persistent or recurrent disease in 304 patients.
abstract: BACKGROUND
  Subtotal parathyroidectomy (SPTX) and total parathyroidectomy with autotransplantation (TPTX and AT) are standard procedures in the treatment of renal autonomous hyperparathyroidism. In contrast to primary hyperparathyroidism, the persistence/recurrence rate is reported of up to 12.0%.
  
  
  METHODS
  Between 1986 and 2000 we operated on 304 patients with renal autonomous hyperparathyroidism including 14 patients who were admitted after a primary operation in an outside hospital. Mean observation period was 51.4+/-38.9 months.
  
  
  RESULTS
  The overall persistence/recurrence rate in our patients was 9.0% (26/290). After SPTX, excluding patients with an incomplete operation, it was 3.7%, and after TPTX and AT it was 6.0%. Reasons for developing recurrent or persistent disease in these patients were removal of less than 3.5 glands ( n=12), hyperplastic autograft ( n=5), and supernumerary gland ( n=4). After the first reoperation 7 patients (26.9%) had persistent or recurrent disease.
  
  
  CONCLUSIONS
  An incomplete primary operation caused by missed cervical glands was the major reason for persistent ( n=8) or recurrent ( n=4) disease after different operative strategies in renal autonomous hyperparathyroidism.
authors.affiliation: Department of Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. dotzenr@uni-duesseldorf.de
authors.forename: C
authors.initials: C
authors.lastname: Dotzenrath
authors.forename: K
authors.initials: K
authors.lastname: Cupisti
authors.forename: E
authors.initials: E
authors.lastname: Goretzki
authors.forename: A
authors.initials: A
authors.lastname: Mondry
authors.forename: A
authors.initials: A
authors.lastname: Vossough
authors.forename: B
authors.initials: B
authors.lastname: Grabensee
authors.forename: H-D
authors.initials: HD
authors.lastname: Röher
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014182:Transplantation, Autologous; D016896:Treatment Outcome