Medical Management and Surgical Indications of Secondary Hyperparathyroidism

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The primary treatment for secondary hyperparathyroidism:
    • Is medical using:
      • Calcium supplementation
      • Phosphate binders
      • Vitamin D
      • Calcitriol
      • Calcimimetics:
        • Such as cinacalcet
  • Therapy is targeted to:
    • Reduce serum calcium and phosphate:
      • With improvement in medical management through the advent of:
        • Vitamin D analogs and cinacalcet:
          • Rates of parathyroidectomy for secondary hyperparathyroidism have declined
  • Indications for parathyroidectomy include:
    • Failure of medical management, including:
      • Persistent hypercalcemia
      • Persistent hyperphosphatemia
      • PTH less than 800 pg/mL
      • Additionally, uncontrollable symptoms including:
        • Intractable pruritus
        • Skeletal pain or fractures
        • Progressive extraskeletal calcifications
  • Removal of the parathyroid glands in secondary hyperparathyroidism:
    • Has been shown to quickly lower calcium, phosphorus, and PTH:
      • It is associated with greater survival in patients on hemodialysis
  • It is estimated that 0.5% to 2% of patients with end-stage renal disease:
    • Require parathyroidectomy for secondary hyperparathyroidism
  • Additional indications for surgery include:
    • Patient preference and inability to establish routine medical follow-up
  • Calciphylaxis:
    • Is a rare complication of secondary hyperparathyroidism resulting in acute deposition of calcium in tissues and skin necrosis:
      • That may lead to a systemic inflammatory response and is associated with a high rate of mortality (87% to 93%) Figure
Patient with chronic renal failure and calciphylaxis of the lower extremities. Lesions are superficial erosions with islands of intervening granulation tissue and areas of eschar. The surrounding skin was violaceous and very tender to palpation (b). Characteristic histologic findings in calciphylaxis. Photomicrograph (original magnification × 400) showing three blood vessels with surrounding mineralization, indicated by arrows.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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