Relationship between parathyroid mass and parathyroid hormone level in hemodialysis patients with secondary hyperparathyroidism

BMC Nephrology

Junwei Yang²  Mingxia Xiong²  Meijuan Meng²  Dawei Hou¹  Bing Tang²  Li Fang² 

[1] Department of General Surgery, 2nd Affiliated Hospital, Nanjing Medical University, 262 Zhongshan North Road, Nanjing, Jiangsu Province, China;Center for Kidney Disease, 2nd Affiliated Hospital, Nanjing Medical University, 262 Zhongshan North Road, Nanjing, Jiangsu Province, China

关键词: Parathyroid hormone;    Parathyroid gland mass;    Total parathyroidectomy;    Secondary hyperparathyroidism;   

Others  :  1220062
DOI  :  10.1186/s12882-015-0077-6

 received in 2014-09-29, accepted in 2015-05-21,  发布年份 2015

【 摘 要 】

Background

To evaluate the influence of parathyroid mass on the regulation of parathyroid hormone (PTH) secretion, we investigated the relationship between the resected parathyroid gland in total parathyroidectomy and the parathyroid hormone level in hemodialysis patients with secondary hyperparathyroidism.

Methods

From January 2009 to July 2014, 223 patients undergoing total parathyroidectomy were included. The size and the weight of parathyroid gland were measured during the operation.

Results

874 parathyroid glands were removed. A positive correlation was identified between the size and the weight of resected parathyroid glands. We found that both the preoperative PTH and the reduction of PTH were significantly correlated with the size and the weight of parathyroid glands in a positive manner. However, in the subgroup of patients with PTH < 1000 pg/ml, no significant correlation was found.

Conclusions

Larger parathyroid gland secretes more PTH and high level of serum PTH usually indicated that surgical removal might be required. However, since PTH levels could be influenced by the pharmaceutical drug, the large size of parathyroid gland might be used as a much more appropriate guide that indicates the requirement of surgery treatment even when the parathyroid hormone was less than 1000 pg/ml.

【 授权许可】

   
2015 Fang et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

【 参考文献 】

• [1]Guideline Working Group, Japanese Society for Dialysis Therapy. Clinical practice guideline for the management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial. 2008, 12(6):514–525.
• [2]Drueke TB. Cell biology of parathyroid gland hyperplasia in chronic renal failure. J Am Soc Nephrol. 2000; 11(6):1141-52.
• [3]Rodriguez M, Canalejo A, Garfia B, Aguilera E, Almaden Y. Pathogenesis of refractory secondary hyperparathyroidism. Kidney Int Suppl. 2002; 80:155-60.
• [4]Cozzolino M, Brancaccio D, Gallieni M, Galassi A, Slatopolsky E, Dusso A. Pathogenesis of parathyroid hyperplasia in renal failure. J Nephrol. 2005; 18(1):5-8.
• [5]Coburn JW, Maung HM, Elangovan L, Germain MJ, Lindberg JS, Sprague SM, Williams ME, Bishop CW. Doxercalciferol safely suppresses PTH levels in patients with secondary hyperparathyroidism associated with chronic kidney disease stages 3 and 4. Am J Kidney Dis. 2004; 43(5):877-90.
• [6]Block GA, Martin KJ, de Francisco AL, Turner SA, Avram MM, Suranyi MG, Hercz G, Cunningham J, Abu-Alfa AK, Messa P et al.. Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med. 2004; 350(15):1516-25.
• [7]Chertow GM, Lu ZJ, Xu X, Knight TG, Goodman WG, Bushinsky DA, Block GA. Self-reported symptoms in patients on hemodialysis with moderate to severe secondary hyperparathyroidism receiving combined therapy with cinacalcet and low-dose vitamin D sterols. Hemodial Int. 2012; 16(2):188-97.
• [8]Lewin E, Garfia B, Recio FL, Rodriguez M, Olgaard K. Persistent downregulation of calcium-sensing receptor mRNA in rat parathyroids when severe secondary hyperparathyroidism is reversed by an isogenic kidney transplantation. J Am Soc Nephrol. 2002; 13(8):2110-6.
• [9]Lewin E, Olgaard K. Influence of parathyroid mass on the regulation of PTH secretion. Kidney Int Suppl. 2006; 102:S16-21.
• [10]Fukagawa M, Komaba H, Onishi Y, Fukuhara S, Akizawa T, Kurokawa K. Mineral metabolism management in hemodialysis patients with secondary hyperparathyroidism in Japan: baseline data from the MBD-5D. Am J Nephrol. 2011; 33(5):427-37.
• [11]Yuan CM, Nee R, Narayan R, Abbott KC. Treatment of secondary hyperparathyroidism with parathyroidectomy instead of cinacalcet: time to pick the low-hanging fruit? Am J Kidney Dis. 2012; 60(2):179-81.
• [12]Slinin Y, Foley RN, Collins AJ. Clinical epidemiology of parathyroidectomy in hemodialysis patients: the USRDS waves 1, 3, and 4 study. Hemodial Int. 2007; 11(1):62-71.
• [13]Fuster D, Ybarra J, Ortin J, Torregrosa JV, Gilabert R, Setoain X, Paredes P, Duch J, Pons F. Role of pre-operative imaging using 99mTc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. Eur J Nucl Med Mol Imaging. 2006; 33(4):467-73.
• [14]McCarron DA, Muther RS, Lenfesty B, Bennett WM. Parathyroid function in persistent hyperparathyroidism: relationship to gland size. Kidney Int. 1982; 22(6):662-70.
• [15]Gagne ER, Urena P, Leite-Silva S, Zingraff J, Chevalier A, Sarfati E, Dubost C, Drueke TB. Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J Am Soc Nephrol. 1992; 3(4):1008-17.
• [16]Yokoyama K, Taniguchi M, Fukagawa M. A Japanese approach for CKD-MBD. Kidney Int Suppl (2011). 2013; 3(5):451-6.
• [17]Goodman WG, Quarles LD. Development and progression of secondary hyperparathyroidism in chronic kidney disease: lessons from molecular genetics. Kidney Int. 2008; 74(3):276-88.
• [18]Neyer U, Hoerandner H, Haid A, Zimmermann G, Niederle B. Total parathyroidectomy with autotransplantation in renal hyperparathyroidism: low recurrence after intra-operative tissue selection. Nephrol Dial Transplant. 2002; 17(4):625-9.
• [19]Cunningham J, Locatelli F, Rodriguez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol. 2011; 6(4):913-21.
• [20]Komaba H, Nakanishi S, Fujimori A, Tanaka M, Shin J, Shibuya K, Nishioka M, Hasegawa H, Kurosawa T, Fukagawa M. Cinacalcet effectively reduces parathyroid hormone secretion and gland volume regardless of pretreatment gland size in patients with secondary hyperparathyroidism. Clin J Am Soc Nephrol. 2010; 5(12):2305-14.
• [21]Naranda J, Ekart R, Pecovnik-Balon B. Total parathyroidectomy with forearm autotransplantation as the treatment of choice for secondary hyperparathyroidism. J Int Med Res. 2011; 39(3):978-87.
• [22]Ichii M, Ishimura E, Okuno S, Chou H, Kato Y, Tsuboniwa N, Nagasue K, Maekawa K, Yamakawa T, Inaba M et al.. Decreases in parathyroid gland volume after cinacalcet treatment in hemodialysis patients with secondary hyperparathyroidism. Nephron Clin Pract. 2010; 115(3):c195-202.
• [23]Alexandrides TK, Kouloubi K, Vagenakis AG, Yarmenitis S, Spyridonidis T, Vassilakos P, Apostolopoulos D. The value of scintigraphy and ultrasonography in the preoperative localization of parathyroid glands in patients with primary hyperparathyroidism and concomitant thyroid disease. Hormones (Athens). 2006; 5(1):42-51.
• [24]Chertow GM, Dillon M, Burke SK, Steg M, Bleyer AJ, Garrett BN, Domoto DT, Wilkes BM, Wombolt DG, Slatopolsky E. A randomized trial of sevelamer hydrochloride (RenaGel) with and without supplemental calcium. Strategies for the control of hyperphosphatemia and hyperparathyroidism in hemodialysis patients. Clin Nephrol. 1999; 51(1):18-26.
• [25]Slatopolsky EA, Burke SK, Dillon MA. RenaGel, a nonabsorbed calcium- and aluminum-free phosphate binder, lowers serum phosphorus and parathyroid hormone. The RenaGel Study Group. Kidney Int. 1999; 55(1):299-307.
• [26]Akiba T, Marumo F, Owada A, Kurihara S, Inoue A, Chida Y, Ando R, Shinoda T, Ishida Y, Ohashi Y. Controlled trial of falecalcitriol versus alfacalcidol in suppression of parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism. Am J Kidney Dis. 1998; 32(2):238-46.