Secondary hyperparathyroidism due to end stage renal disease occurs in about 50 to 60% dialysis patients. Symptoms as weakness, pruritus and physical abnormalities as calciphylaxis and skeletal deformities may occur due to persistent high levels of parathyroid hormone, calcium and phosphorus. Clinical management is the first option therapy, and it’s successful in about 90% of patients. Nevertheless, certain events indicate the need to consider parathyroid surgery in these patients, as extreme high levels of parathyroid hormone, calcium and phosphorous and the presence of tertiary hyperparathyroidism. The aim of this study was to evaluate clinical and laboratory data in the pre-operative, and surgical findings among patients with secondary hyperparathyroidism, tertiary hyperparathyroidism before and after renal transplantation in search of parathyroid autonomy evidences. Method : Reports of seventy patients who underwent parathyroid surgery from March 1997 to June 2003 were evaluated in a historic prospective way. These subjects were separated in groups according to their hyperparathyroidism classification. We analyzed clinical data before surgery, laboratory measurements of parathyroid hormone, ionized calcium and phosphorous, surgical procedures and glandular volume of removed parathyroids.
Results : There was a significant relation between total parathyroidectomy with parathyroid autograft procedure and tertiary hyperparathyroidism after renal transplantation group, as well as between total parathyroidectomy without parathyroid autograft procedure in tertiary hyperparathyroidism before renal transplantation group. There was not differences among secondary hyperparathyroidism patients, tertiary hyperparathyroidism before renal transplantation (autonomy) and tertiary hyperparathyroidism after renal transplantation patients regarding to months in dialysis preceding parathyroidectomy. Glandular volume of all removed parathyroids was significant larger in tertiary hyperparathyroidism before renal transplantation group and the largest one was the responsible for this result. There wasn’t relation between months of dialysis and glandular volume, neither surgery procedure. Taking into account clinical findings as skeletal deformities, calciphylaxis, extraskeletal calcifications, muscle pain and neuropathy, there wasn’t differences among groups. Nevertheless, pruritus and weakness were significant more frequent in tertiary hyperparathyroidism before renal transplantation group. Regarding to laboratory measurements, parathyroid hormone and phosphorous were significant lower in tertiary hyperparathyroidism after renal transplantation group.
Conclusion : Tertiary hyperparathyroidism before renal transplantation group presents glandular volume of removed parathyroids larger than secondary hyperparathyroidism group and tertiary hyperparathyroidism after renal transplantation group. This occurred due to asymmetrical enlargement of one parathyroid (the largest one). There are not clinical findings difference among secondary hyperparathyroidism patients and tertiary hyperparathyroidism before renal transplantation patients (autonomy). Presence of pruritus and weakness is significant higher in tertiary hyperparathyroidism before renal transplantation group. There are not differences among secondary hyperparathyroidism patients, tertiary hyperparathyroidism before renal transplantation (autonomy) and tertiary

hyperparathyroidism after renal transplantation patients regarding to months in dialysis preceding parathyroidectomy. Ther efore, there isn’t relation between time in dialysis and evolution to autonomy. There are not relation between months of dialysis and glandular volume. Parathyroid hormone and phosphorous measurements aren’t different among secondary hyperparathyroidism patients and tertiary hyperparathyroidism before renal transplantation (autonomy) patients.
Parathyroid hormone and phosphorous levels are significant lower in tertiary hyperparathyroidism after renal transplantation group.