Operative treatment of renal autonomous hyperparathyroidism: cause of persistent or recurrent disease in 304 patients.
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.
Dotzenrath
C
C
Department of Surgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. dotzenr@uni-duesseldorf.de
Cupisti
K
K
Goretzki
E
E
Mondry
A
A
Vossough
A
A
Grabensee
B
B
Röher
H-D
HD
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