title: [Surgical treatment of secondary hyperparathyroidism. A clinical study of 70 patients].
abstract: OBJECTIVE
  The authors analyze the short and long-term results of surgical treatment in 70 consecutive patients operated on from for secondary Hyperparathyroidism (2HPT) of chronic kidney disease (CKD).
  
  
  METHODS
  Seventy patients affected by 2HPT of CKD, in hemodialytic treatment, were observed from January 1999 to January 2009. Twenty-seven patients were submitted to total parathyroidectomy (TP), 36 pts were submitted to total parathyroidectomy plus subcutaneous autoimplantation (TP ai), 7 pts were submitted to subtotal parathyroidectomy (SP).
  
  
  RESULTS
  An improvement of the typical clinical symptoms was found in every patient undergoing surgery, and a significant reduction in intact parathyroid hormone (iPTH) serum levels was achieved TP determined a lower incidence of one year relapse. After TPai 9/36 pts successfully underwent renal transplantation.
  
  
  CONCLUSIONS
  To date surgical treatment of 2HPT is still controversial. SP and TPai are the most commonly adopted surgical interventions while TP had been previously been confined to patients with advanced dialytic vintage or for the treatment of recurrence, for the risks arising from aparathyroidism. TP allows a lower long-term relapse incidence and managing the resulting hypoparathyroidism appears straightforward with medical treatment.
  
  
  CONCLUSIONS
  The Authors are in favour of early surgical intervention to prevent cardiovascular complications. TPai may be the operation of choice in patients eligible for kidney transplantation while TP carachterized by a lower incidence of long term relapse, is reserved to patients not eligible for transplantation and affected by a more "aggressive" forms of 2HPT.
authors.affiliation: Seconda Università degli Studi di Napoli, IV Divisione di Chirurgia Generale e di Endocrinochirurgia Dipartimento di Clinica e Medicina Sperimentale F. Magrassi-A. Lanzara, Italia. giovanni.conzo@uni-na2.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Antonietta
authors.initials: A
authors.lastname: Palazzo
authors.forename: Cristina
authors.initials: C
authors.lastname: Della Pietra
authors.forename: Francesco
authors.initials: F
authors.lastname: Stanzione
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Candilio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.forename: Antonio
authors.initials: A
authors.lastname: Livrea
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy