Dynamics of parathyroid hormone secretion after total parathyroidectomy and autotransplantation.
BACKGROUND
Secondary hyperparathyroidism is a common complication in uremic patients. Total parathyroidectomy combined with partial autotransplantation into brachioradialis muscle has been the preference among the options for surgical treatment. This study was designed to evaluate the reserve and ability of suppression of autotransplanted parathyroid tissue using dynamics tests.


METHODS
We studied, prospectively, 12 patients in recent (RP) and late (LP) postoperative of total parathyroidectomy with autotransplantation. For analysis of the secretory reserve capacity, we induced hypocalcemia by ethylenediaminetetraacetic acid (EDTA) infusion. Furthermore, for analysis of the ability for parathyroid hormone (PTH) suppression, the hypercalcemia test was used, by intravenous administration of calcium in LP.


RESULTS
In RP, there was a decrease in the average serum levels of PTH, phosphorus, and alkaline phosphatase, which ranged from 13 to 231 (87 +/- 65) pg/ml, 2.3 to 6.2 (3.3 +/- 1.1) mg/dl, and 77 to 504 (250 +/- 135) U/L, respectively, similar to that observed in LP. The analysis of the average curve of variations in PTH during testing of the stimulus with EDTA showed lack of secretion in RP and partial response in LP. Impaired suppression ability of the graft in LP was observed in the test with intravenous calcium.


CONCLUSIONS
Total parathyroidectomy followed by partial autotransplantation was effective in reducing PTH serum levels in patients with terminal kidney disease. The elevation of serum calcium during the suppression test was not able to inhibit the autograft gland secretion of PTH. The assessment of parathyroid graft function demonstrated an inability to respond to the stimulus of hypocalcemia induced by EDTA, although there was a partial recovery, in late postoperative period.
Conti-Freitas
Luiz Carlos
LC
Department of Ophthalmology, Otolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School of São Paulo University-USP, Ribeirão Preto, Brazil. lcconti@uol.com.br
Foss-Freitas
Maria Cristina
MC
Lucca
Leandro Junior
LJ
da Costa
Jose Abrão Cardeal
JA
Mamede
Rui Celso Martins
RC
Foss
Milton Cesar
MC
D000328:Adult; D001499:Bayes Theorem; D002118:Calcium / Q000097:blood* / Q000378:metabolism; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation*; D010281:Parathyroid Hormone / Q000097:blood / Q000378:metabolism*; D016105:Parathyroidectomy / Q000379:methods*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014182:Transplantation, Autologous / Q000379:methods*; D016896:Treatment Outcome
D010281:Parathyroid Hormone; D002118:Calcium