BIOPSY-PROVEN PARATHYROIDECTOMY AND ITS CLINICAL PARAMETERS IN UHC RIJEKA PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

Hypocalcemia and hyperphosphatemia in chronic kidney disease (CKD) lead to abnormal parathyroid hormone (PTH) excretion and hyperplasia of parathyroid glands. This condition can be treated by pharmacological agents, but if it does not show satisfying effect parathyroidectomy is indicated. Histopatological data and clinical parameters in CKD patients with secondary hyperparathyroidisim (SHP) who had parathyroidectomy are presented in this trial. Aim was to analyse histopatological and clinical data of CKD patients with SHP who had parathyroidectomy. Also to present the sucess of parathyroidectomy in regulation of PTH and other laboratory parameters and to compare the size of parathyroid glands. Our center provided data of all biopsies of native parathyroid glands performed during the period of 2003.-2015. This data was compared with laboratory parameters before parathyroidectomy and one year after the operative procedure.Parathyroidectomy was performed in 23 patients. 18 patients were analysed in this trial (10 female and 8 male), because they had complete data.The mean age was 55.5±11.6 years and the mean duration of hemodialysis was 87±71.6 months. Clinical indications for parathyroidectomy were: bone pain (94.4%), fracture (11.1%), metastatic calcification (5.6%) and pruritus (11.1%). The mean laboratory values before the operation were: calcium 2.5±0.3 mmol/L, phosphates 1.8±0.5 mmol/L, ALP 228.5±162.1 U/L and PTH 173.2±68.8 pmol/L. 14 patients had subtotal and 4 patients total paratyroidectomy ; there was also one reoperation. Total number of glands was 59 ( 9 up-right, 12 up-left, 17 down- right, 15 down-left and 6 with unusual position). 55 glands had nodular hyperplasia and 4 had diffuse hyperplasia. The mean dimension of upper glands was 1.75±0.57 cm ; mean dimension of lower glands was 1.90±1.05 cm. There was statistically significant correlation between PTH value and dimensions of upper glands (p=0.04). One year after parathyroidectomy the mean value of laboratory parameters was: calcium 2.1±0.4 mmol/L (p=0.0006), phosphates 1.2±0.4 mmol/L (p=0.0007), ALP 113.6±80.2 U/L (p=0.002) and PTH 17.2±13.6 pmol/L (p<0.0001). This retrospective study has proven that parathyroidectomy is very successful treatment in patients with SHP. Study also confirmed that lower glands are bigger than upper ones and that there is positive correlation between the size of upper parathyroid glands and PTH value.