J.Jpn. Surg. Soc.. 81(8): 791-801, 1980

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Original article

SURGICAL TREATMENT OF HYPERPARATHYROIDISM IN CHRONIC RENAL FAILURE
－EXPERIENCE OF SUBTOTAL PARATHYROIDECTOMY IN NINE CASES AND RENAL HOMOTRANSPLANTATION IN TWO CASES－

Eight patients on hemodialysis for five months to six years because of chronic renal failure and one patient who developed aseptic necrosis of the formal head after a kidney transplant underwent subtotal parathyroidectomy. Radiologically typical osteodystrophy in seven cases, high parathyroid hormone (PTH) level in seven cases, persistent pruritus in five cases, and soft tissue calcification in four cases, were considered as indications for this operation. The largest excised parathyroid glands weighed 5.7 g and the second largest one weighed 2.2 g. Histologically, they showed mainly chief cell hyperplasia, with adenomatous change in one case. Remarkable improvement was observed immediately with pruritus, bone pain and PTH level. Soft tissue calcification disappeared in a few weeks and bony changes improved in a few months. Occasional postoperative hypocalcemia was controlled by supplemental calcium and 1α-OH-D3.
Two patients (LD 61 and 64) who developed apparent hyperparathyroidism after hemodialysis longer than five years underwent renal homotransplantation from their parents. Significant and uniform improvement of all parameters was observed in the case of LD 61. However, in the case of LD 64, although apparent improvement was observed for serum alkaline phosphatase and PTH level and osteodystrophy on X-ray films, hyperphosphaturic hypophosphatemia still persists even with phosphate supplementation in spite of satisfactory graft function. PTH independent phosphate leakage due to tubular dysfunction of the graft is suspected.

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