Optimizing Surgical Management of Renal Hyperparathyroidism: Insights from a Single-Center Experience

Öz

Aim: Renal hyperparathyroidism is one of the most common complications in patients with end-stage renal disease and is often resistant to medical treatment. Surgical treatment remains the only definitive option in cases resistant to pharmacological management.
Method: We retrospectively reviewed 480 patients who underwent parathyroid surgery between June 2020 and June 2025. Among them, 26 had renal hyperparathyroidism, and after applying exclusion criteria, 14 patients were included in the final analysis. Demographics, surgical strategies, perioperative biochemical data, complications, and follow-up outcomes were assessed.
Results: The study population consisted of 14 patients, including 10 males and 4 females. Patient age ranged from 23 to 61 years, dialysis duration ranged from 2 to 21 years, and length of hospital stay ranged from 3 to 28 days. Surgical approaches included subtotal parathyroidectomy (n=5), total parathyroidectomy (n=4), and purge parathyroidectomy (n=5). Preoperatively, parathyroid hormone levels were markedly elevated and showed a substantial postoperative decline, accompanied by improvements in serum calcium and phosphorus levels. Recurrent laryngeal nerve palsy and disease recurrence were observed in none of the patients with long-term follow-up. Postoperative hypocalcemia requiring intravenous calcium therapy was observed in 5 patients, three of whom had undergone purge parathyroidectomy and two total parathyroidectomy. 
Conclusion: In this retrospective series, parathyroidectomy was associated with marked biochemical improvement in patients with renal hyperparathyroidism refractory to medical management. Surgical approaches were applied according to patient-specific clinical characteristics and intraoperative findings.

Anahtar Kelimeler

• End-stage renal disease
• purge parathyroidectomy
• secondary hyperparathyroidism
• renal hyperparathyroidism

Renal Hiperparatiroidizmde Cerrahi Tedavi Yaklaşımları: Tek Merkez Deneyimi

Öz

Amaç: Sekonder ve tersiyer hiperparatiroidizm, son dönem böbrek yetmezliği olan hastalarda sık görülen ve çoğu zaman medikal tedaviye dirençli olan önemli komplikasyonlardır. Farmakolojik tedaviye yanıt alınamayan olgularda cerrahi tedavi tek seçenek olmaya devam etmektedir.
Yöntem: Haziran 2020 ve Haziran 2025 tarihleri arasında paratiroid cerrahisi uygulanan 480 hasta retrospektif olarak incelendi. Bu hastaların 26’sında renal hiperparatiroidizm mevcuttu. Dışlama kriterleri uygulandıktan sonra 14 hasta çalışmaya dahil edildi. Hastaların demografik özellikleri, uygulanan cerrahi yöntemler, perioperatif biyokimyasal veriler, komplikasyonlar ve takip sonuçları değerlendirildi.
Bulgular: Çalışmaya 10’u erkek, 4’ü kadın olmak üzere toplam 14 hasta dahil edildi. Hastaların yaşları 23–61 yıl arasında değişmekte olup, cerrahi öncesi diyaliz süreleri 2–21 yıl, hastanede yatış süreleri ise 3–28 gün arasında saptandı. Uygulanan cerrahi yaklaşımlar subtotal paratiroidektomi (n=5), total paratiroidektomi (n=4) ve purge paratiroidektomi (n=5) idi. Cerrahi öncesi paratiroid hormon düzeylerinin belirgin derecede yüksek olduğu ve cerrahi sonrası dönemde anlamlı bir düşüş gösterdiği, buna eşlik eden serum kalsiyum ve fosfor düzeylerinde düzelme izlendi. Uzun dönem takibi bulunan hastaların hiçbirinde rekürren laringeal sinir paralizisi veya hastalık nüksü saptanmadı. İntravenöz kalsiyum tedavisi gerektiren postoperatif hipokalsemi beş hastada gözlendi; bu hastaların üçüne purge paratiroidektomi, ikisine ise total paratiroidektomi uygulanmıştı.
Sonuç: Bu retrospektif seride, paratiroidektomi medikal tedaviye dirençli renal hiperparatiroidizm hastalarında belirgin biyokimyasal iyileşme ile ilişkili bulunmuştur. Cerrahi yaklaşımlar, hasta-özgü klinik özellikler ve intraoperatif bulgular doğrultusunda uygulanmıştır.

Anahtar Kelimeler

• Purge paratiroidektomi
• renal hiperparatiroidizm
• son dönem böbrek yetmezliği
• sekonder hiperparatiroidizm

Kaynakça

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