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Treatment for secondary hyperparathyroidism focusing on parathyroidectomy

Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (...

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Autores principales: Hiramitsu, Takahisa, Hasegawa, Yuki, Futamura, Kenta, Okada, Manabu, Goto, Norihiko, Narumi, Shunji, Watarai, Yoshihiko, Tominaga, Yoshihiro, Ichimori, Toshihiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159274/
https://www.ncbi.nlm.nih.gov/pubmed/37152972
http://dx.doi.org/10.3389/fendo.2023.1169793
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author Hiramitsu, Takahisa
Hasegawa, Yuki
Futamura, Kenta
Okada, Manabu
Goto, Norihiko
Narumi, Shunji
Watarai, Yoshihiko
Tominaga, Yoshihiro
Ichimori, Toshihiro
author_facet Hiramitsu, Takahisa
Hasegawa, Yuki
Futamura, Kenta
Okada, Manabu
Goto, Norihiko
Narumi, Shunji
Watarai, Yoshihiko
Tominaga, Yoshihiro
Ichimori, Toshihiro
author_sort Hiramitsu, Takahisa
collection PubMed
description Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and (99m)Tc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed via intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients’ need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described.
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spelling pubmed-101592742023-05-05 Treatment for secondary hyperparathyroidism focusing on parathyroidectomy Hiramitsu, Takahisa Hasegawa, Yuki Futamura, Kenta Okada, Manabu Goto, Norihiko Narumi, Shunji Watarai, Yoshihiko Tominaga, Yoshihiro Ichimori, Toshihiro Front Endocrinol (Lausanne) Endocrinology Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and (99m)Tc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed via intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients’ need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described. Frontiers Media S.A. 2023-04-20 /pmc/articles/PMC10159274/ /pubmed/37152972 http://dx.doi.org/10.3389/fendo.2023.1169793 Text en Copyright © 2023 Hiramitsu, Hasegawa, Futamura, Okada, Goto, Narumi, Watarai, Tominaga and Ichimori https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Hiramitsu, Takahisa
Hasegawa, Yuki
Futamura, Kenta
Okada, Manabu
Goto, Norihiko
Narumi, Shunji
Watarai, Yoshihiko
Tominaga, Yoshihiro
Ichimori, Toshihiro
Treatment for secondary hyperparathyroidism focusing on parathyroidectomy
title Treatment for secondary hyperparathyroidism focusing on parathyroidectomy
title_full Treatment for secondary hyperparathyroidism focusing on parathyroidectomy
title_fullStr Treatment for secondary hyperparathyroidism focusing on parathyroidectomy
title_full_unstemmed Treatment for secondary hyperparathyroidism focusing on parathyroidectomy
title_short Treatment for secondary hyperparathyroidism focusing on parathyroidectomy
title_sort treatment for secondary hyperparathyroidism focusing on parathyroidectomy
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159274/
https://www.ncbi.nlm.nih.gov/pubmed/37152972
http://dx.doi.org/10.3389/fendo.2023.1169793
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