title: Surgical parathyroidectomy versus cinacalcet therapy: in the management of secondary hyperparathyroidism.
abstract: OBJECTIVE
  The aim of this study was to compare the clinical effectiveness of surgery with calcimimetics as treatment strategies for managing the biochemical abnormalities that characterize secondary hyperparathyroidism (2HPTH), resistant to optimal conventional therapy in patients with end-stage renal failure (ESRF).
  
  
  METHODS
  A historical cohort study.
  
  
  METHODS
  Maxillofacial Department, Morriston Hospital, Swansea, United Kingdom.
  
  
  METHODS
  Fifty-four patients with 2HPTH resistant to optimal conventional medical management were studied. One cohort of 20 patients was treated with surgical parathyroidectomy, the other cohort of 34 patients with cinacalcet. Serum parathyroid hormone (PTH) and bone profile were measured before and at monthly intervals after intervention.
  
  
  RESULTS
  Both cohorts were comparable in their demographic profile, pretreatment comorbidities, baseline PTH, and bone profile. In all 20 surgical patients, the 1-week postoperative PTH had decreased by 97% (P < .001); in the medical cohort after 4 months of daily cinacalcet, the PTH decreased by 48% (P < .001) from baseline. This reduction was maintained at 18 months. In all but 1 surgical patient, alkaline phosphatase (ALP) decreased to normal levels, whereas on cinacalcet, there was no statistically significant reduction. Patients who underwent parathyroidectomy had a more significant decrease in PTH (P < .001) and ALP (P < .0014) than did patients on cinacalcet therapy. All patients managed surgically who complained of preoperative symptoms of pruritis and bone pain expressed complete resolution or significant improvement after parathyroidectomy (P < .001, P < .003, respectively).
  
  
  CONCLUSIONS
  Surgery was superior to "medical" parathyroidectomy in controlling PTH and ALP.
authors.affiliation: Maxillofacial Department, Morriston Hospital, Swansea, United Kingdom.
authors.forename: Assia
authors.initials: A
authors.lastname: Ghani
authors.forename: Prudence
authors.initials: P
authors.lastname: Baxter
mesh_terms: D000069449:Cinacalcet; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D010281:Parathyroid Hormone; D016105:Parathyroidectomy
chemical_list: D009281:Naphthalenes; D010281:Parathyroid Hormone; D000069449:Cinacalcet