Long-term prognosis of parathyroid function for chronic dialysis patients after minimally invasive radioguided parathyroidectomy (MIRP).
BACKGROUND
Minimally invasive radioguided parathyroidectomy (MIRP) for primary hyperparathyroidism for one gland, located by scanning with technetium 99m-labelled sestamibi (MIBI), has been performed. Total parathyroidectomy with autotransplantation or percutaneous ethanol injection therapy (PEIT) for severe secondary hyperparathyroidism (2HPT) has also been performed.


METHODS
The present study examined the possibility of maintaining parathyroid function within a target range [intact parathyroid hormone (i-PTH) <or=300 pg/ml] in the long term after MIRP for 2HPT. Three patients resistant to calcitriol therapy gave their informed consent for MIRP. The principle of MIRP for chronic dialysis patients is to extract a hyper-functioning parathyroid gland resistant to medical therapy, including calcitriol pulse therapy, and then control the remaining glands with medical therapy. The follow-up period for this study was 2 years.


RESULTS
Two of the cases were controlled by MIRP followed by calcitriol pulse therapy. In all three cases, MIBI scintigraphy showed a solitary radioactive nodule; however, ultrasonography showed that in the two cases that were controlled by MIRP and calcitriol pulse therapy, there was one radioactive gland, but in the other case there were three, and this case required additional PEIT for control of hyperparathyroidism.
Kakuta
Takatoshi
T
Departments of Internal Medicine, Tokai University School of Medicine, Japan.
Suzuki
Yutaka
Y
Tadaki
Futoshi
F
Tanaka
Reika
R
Tanaka
Shinichi
S
Sakai
Hideto
H
Kurokawa
Kiyoshi
K
Saito
Akira
A
D000328:Adult; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010280:Parathyroid Glands / Q000503:physiopathology*; D016105:Parathyroidectomy; D011184:Postoperative Period; D011379:Prognosis; D011877:Radionuclide Imaging; D006435:Renal Dialysis; D025321:Surgery, Computer-Assisted; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors
D017256:Technetium Tc 99m Sestamibi