[The incidence of tertiary hyperparathyroidism after renal transplantation].
BACKGROUND
Tertiary hyperparathyroidism (3 degrees HPT) is a condition characterized by autonomous secretion of parathyroid hormone (PTH) which develops as a consequence of secondary hyperparathyroidism in patients with chronic renal failure. Severe cases of 3 degrees HPT are treated with parathyroidectomy (Ptx). The purpose of this study was to uncover the incidence of 3 degrees HPT and frequency of Ptx after renal transplantation (Tx). Furthermore, we wanted to identify parameters that predicted the development of 3 degrees HPT and the prognosis.


METHODS
The study included 189 consecutive patients who underwent Tx at Odense University Hospital from 1/1/2000 to 12/31/2004. We defined 3 degrees HPT as at least one elevated measurement of P-PTH concurrent with elevated S-Ca2+. Elevated S-Ca2+ was defined as at least 5 consecutive, elevated measurements from 14 days to six months after Tx.


RESULTS
A total of 59 patients (39%) developed 3 degrees HPT after Tx and 13 (22%) of these underwent Ptx. Diabetes mellitus type-1 (DM type-1) significantly increased the risk of 3 degrees HPT. The median duration from Tx to Ptx was 223 (33-911) days. In non-Ptx patients, the median duration of hypercalcemia due to 3 degrees HPT was 37 months.


CONCLUSIONS
3 degrees HPT occurred in approximately 1/3 of the patients and DM-type-1 increased the risk. Without Ptx regression of 3 degrees HPT was seen even after several years' duration.
Nielsen
Tomas
T
Odense Universitetshospital, Endokrinologisk Afdeling M. tomasnielsen@hotmail.com
Brixen
Kim T
KT
Jespersen
Bente
B
D000328:Adult; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D006961:Hyperparathyroidism / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006962:Hyperparathyroidism, Secondary / Q000209:etiology* / Q000503:physiopathology; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D016105:Parathyroidectomy; D011379:Prognosis; D012307:Risk Factors
D010281:Parathyroid Hormone