- Hyperparathyroidism is an inevitable feature of end-stage renal disease (ESRD):
- It is a result of decreased renal tubular excretion of phosphate and defective 1-α hydroxylase enzyme:
- Which cause impaired renal activation of 25-hydroxycholecalciferal to 1,25 dihydroxycholecalciferol
- These causes hyperphosphatemia and hypovitaminosis D:
- Which result in prolonged hypocalcemia:
- That lead to hyperplasia of the chief cells of the parathyroid glands:
- And eventually increased secretion of parathyroid hormone (PTH)
- That lead to hyperplasia of the chief cells of the parathyroid glands:
- Which result in prolonged hypocalcemia:
- These causes hyperphosphatemia and hypovitaminosis D:
- Which cause impaired renal activation of 25-hydroxycholecalciferal to 1,25 dihydroxycholecalciferol
- It is a result of decreased renal tubular excretion of phosphate and defective 1-α hydroxylase enzyme:
- When the condition is chronic and prolonged:
- The pathologic changes may become irreversible:
- With skeletal resistance to PTH
- Autonomous function of the hyperplastic glands:
- Even with correction of the underlying cause and withdrawal of calcium and calcitriol therapy
- The pathologic changes may become irreversible:
- Parathyroidectomy:
- Is usually warranted in severe refractor renal hyperparathyroidism:
- After failure of pharmacologic treatment with calcitriol, a vitamin D analog, or cinacalcet
- The procedure is also considered when the medical therapy to reduce the level of intact PTH (iPTH):
- Results in unacceptable elevation of the serum calcium and / or phosphorus:
- With the potential for precipitation and increased cardiovascular mortality:
- When the calcium-phosphate product exceeds 55 mg2/dl2) or when the adverse effects of the pharmacotherapy are not tolerated by the patient
- With the potential for precipitation and increased cardiovascular mortality:
- Results in unacceptable elevation of the serum calcium and / or phosphorus:
- Is usually warranted in severe refractor renal hyperparathyroidism:
#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #Hyperparathyroidism #Surgeon #HeadandNeckSurgeon #Teacher #MSMC #MountSinaiMedicalCenter #Miami #Mexico #EndocrineSurgery
Rodrigo Arrangoiz MS, MD, FACS, FSSO 