Effect of calcium supplementation on severe hypocalcemia in patients with secondary hyperparathyroidism after total parathyroidectomy

BACKGROUND Severe hypocalcemia(SH)is a dreaded complication of total parathyroidectomy(TPTX)without auto-transplantation.AIM To compare conventional and preventive calcium supplementation(CS)regimens in terms of SH occurrence after TPTX.METHODS This retrospective study included patients who underwent TPTX between January 2015 and May 2018 at the China-Japan Friendship Hospital.From January 2015 to May 2016,conventional CS was performed in patients who underwent TPTX,with calcium amounts adjusted according to postoperative serum calcium levels.From October 2016 to May 2018,preventive CS was performed according to preoperative alkaline phosphatase(ALP)levels.The patients were defined as lowrisk(ALP<500 U/L)and high-risk(ALP>500 U/L)for SH.All preoperative blood samples were collected in the fasting state on the day before surgery.Postoperative blood samples were obtained at 6-7 AM from the first postoperative day.RESULTS A total of 271 patients were included.These patients were 47.7±11.1 years old,and 57.6%were male.Their mean body mass index(BMI)was 22.9±3.8 kg/m^(2).There were no significant differences in sex,age,BMI,preoperative ALP,serum calcium,serum phosphorus,calcium-phosphorus ratio,and intact parathyroid hormone(iPTH)between the two CS groups.Compared with conventional CS,preventive CS led to lower occurrence rates of hypocalcemia within 48 h(46.0%vs 74.5%,P<0.001)and SH(31.7%vs 64.1%,P<0.001).Multivariable analysis showed that preoperative iPTH levelsodds ratio(OR)=1.001,95%confidence interval(CI:1.000-1.001,P=0.009),preoperative ALP amounts(OR=1.002,95%CI:1.001-1.003,P=0.002),preoperative serum phosphorus levels(OR=8.729,95%CI:1.518-50.216,P=0.015)and preventive CS(OR=0.132,95%CI:0.067-0.261,P<0.001)were independently associated with SH.In patients with preoperative ALP≥500 U/L,only preventive CS(OR=0.147,95%CI:0.038-0.562.P=0.005)was independently associated with SH.CONCLUSION This study suggests that preventive CS could reduce the occurrence of SH,indicating its critical value for hypocalcemia after TPTX.

Sagliker syndrome: A case report of a rare manifestation of uncontrolled secondary hyperparathyroidism in chronic renal failure

BACKGROUND Sagliker syndrome(SS)resulting from uncontrolled secondary hyperparathyroidism(SHPT)in chronic renal failure(CRF)is seldom reported.CASE SUMMARY A 24-year-old woman presented with asymmetric facial deformity and stature shortening.She was diagnosed with SS,SHPT,CRF,and thyroid cancer.The patient underwent a total parathyroidectomy and thyroidectomy with central lymph node dissection.The patient’s condition was stable and was discharged from the hospital.CONCLUSION Undergoing dialysis vintage,presenting high serum phosphate levels,and female gender may be risk factors for SS.Intramembranous ossification in the craniomaxillofacial region is possibly activated in this special pathophysiological condition.What’s more,the choice of surgery mainly depends on the treatment goal and the experience of the individual surgeon.

Thromboelastographic Profile of Patients with Hyperparathyroidism Secondary to Chronic Kidney Failure Submitted to Total Parathyroidectomy

Coagulopathy in surgical patients can cause perioperative complications, as both bleeding and thromboembolic events increase surgical morbimortality. The recognition of preexisting disorders and the understanding of the dynamic changes in hemostasis during surgery are prerequisites of safe patient management. The perioperative management of patients with chronic kidney failure is a huge challenge due to both the hypercoagulable state and increased risk of bleeding. Classic laboratory exams performed for the evaluation of blood clotting seem insufficient regarding the determination of the risk of bleeding and thrombosis in surgical patients. As patients with chronic kidney failure develop secondary hyperparathyroidism, the aim of the present study was to describe a case series and correlate the perioperative thromboelastographic profile of patients with chronic kidney failure submitted to parathyroidectomy with their secondary hyperparathyroidism.

Overexpression of parathyroid pituitary-specific transcription factor （Pit）-I in hyperphosphatemia-induced hyperparathyroidism of chronic renal failure rats

Background Hyperphosphatemia in renal failure has been identified as a major role in the pathogenesis of hyperparathyroidism that is independent of changes in serum calcium and 1,25（OH）203. The aim of this study was to evaluate the expression of parathyroid Pit-1 in hyperphosphatemia-induced secondary hyperparathyroidism （SHPT） of chronic renal failure （CRF） rats. Methods Wistar rats with CRF induced by 5/6 nephrectomy were ramdomly fed with diet containing 1.2% inorganic phosphate （Pi, high phosphate （HP） group, n=-9） or 0.2% Pi （low phosphate （LP） group, n=9） for 10 weeks starting from the fourth week after the surgery. Another 7 nephrectomy rats with HP diet were intraperitoneally injected with phosphonoformic acid （PFA, the specific inhibitor of Pit-l, HP＋PFA group） 0.15 g/kg every other day for 10 weeks starting from HP diet. Another 6 HP rats injected with the same amount of normal saline as the control of the HP＋PFA group （HP＋saline group）. At the same time, 9 rats with sham surgery received HP diet as the controls. At the 4th week and 14th week, blood was taken for measurement of serum creatinine （SCr）, serum calcium （SCa）, serum phosphorus （SPi）, 1,25（OH）2D3 and intact parathyroid hormone （iPTH）. At the 14th week, two parathroid glands （PTGs） of each rat were removed by microsurgery, one gland for immunohistochemistry analysis of proliferating cell nuclear antigen （PCNA）, the other one for detection of Pit-1 by Western blotting, and for the measurement of Pit-1 mRNA and PTH mRNA by real-time quantitative polymerase chain reaction. Results In nephrectomy rats, high dierary phosphate induced a marked increase in serum phosphate, iPTH, PTH mRNA and PCNA parathyroid cells, accompanying Pit-1 and its mRNA in parathyroid gland increased significantly. However, serum Ca and 1,25（OH）2D3 remained unchanged. PFA decreased Pit-1 and its mRNA levels to reduce intact PTH, PTH mRNA and PCNA-positive parathyroid cells. Conclusions Expression of parathyroid Pit-1 in hyperphosphatemia-induced SHPT of CRF rats was upregulated. Pit-1 may mediate the stimulation to parathyroid gland by hyperphosphatemia.

Parathyroidectomy in Chronic Haemodialysis in the Nephrology and Haemodialysis Department at the University Hospital Center of Point G in Bamako, Mali

Introduction: Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. Objective: To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. Results: We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis time). There were no cases of complications or mortality. Conclusion: Parathyroidectomy is an effective treatment to curb hypersecretion of parathyroid hormone. Despite this satisfactory result, the management of phosphocalcic abnormalities in renal failure remains an ongoing concern.

Vitamin D and Parathyroid Hormone Profiles in Living Kidney Failure Patients in Côte d’Ivoire

Introduction: Abnormalities in mineral and bone metabolism, particularly phosphocalcic metabolism, are common in renal failure and are associated with a significant morbidity and mortality. The regulation of phosphocalcic metabolism is subject to a particularly precise and complex control of parathormone (PTH) and vitamin D. Assessment of vitamin D and parathyroid hormone concentrations would help to improve the medical management of patients with chronic kidney disease and ensure a better quality of life. Methods: The study population consisted of 138 individuals including 46 non- dialysis renal failure patients, 46 chronic hemodialysis patients and 46 non- renal failure volunteers to serve as controls. Serum Parathyroid hormone and Vitamin D concentrations were measured using the Vidas automated system. Results: 25-hydroxyvitamin D concentrations in controls (65 ± 2.41 nmol/L) and dialysis patients (70 ± 3.03 nmol/L) were significantly higher than those in CKD patients (48 ± 3.34 nmol/L). On the other hand, the mean values of Parathyroid hormone in dialysis patients (312 ± 36.22 pg/mL) and CKD patients (117 ± 10.68 pg/mL) were very high compared to that in controls (25 ± 2.34 pg/mL). Conclusion: Secondary hyperparathyroidism is common in renal failure. Parathyroid hormone and 25-hydroxyvitamin D assays would be adequate for better management of chronic renal failure.

精准腺体移植量对继发性甲状旁腺功能亢进患者外科治疗的临床效果分析

目的:探讨甲状旁腺全切加前臂移植术中精准腺体移植量治疗继发性甲状旁腺功能亢进患者的临床效果。方法:选取2018年10月—2021年8月期间南通市第三人民医院收治的慢性肾功能衰竭后继发性甲状旁腺功能亢进行甲状旁腺全切加前臂移植术的患者40例,按随机数字表法分为观察组和对照组,各20例。对照组腺体移植量为1 mg/kg体质量;观察组腺体移植量为0.5 mg/kg体质量。观察两组患者术前及术后1 d、5 d、1个月、3个月、6个月、1年的甲状旁腺激素(parathyroid hormone,PTH)、血钙、血磷的变化,及骨痛、皮肤瘙痒的缓解情况。结果:两组患者手术成功率为97.50%。两组患者术后6个月内的PTH、血钙、血磷均较术前有所下降,观察组术后3个月、6个月、1年的PTH均低于对照组(均P<0.05),且观察组PTH上升曲线幅度较对照组减缓。两组患者术后骨痛症状均明显缓解,皮肤瘙痒症状缓解率差异无统计学意义(P>0.05)。结论:甲状旁腺全切加前臂移植术能有效治疗继发性甲状旁腺功能亢进,且指南推荐的范围内较少的精准腺体移植量(0.5 mg/kg体质量)能在短期内有效减缓PTH的上升。

双下肢钙化防御一例

患者,女,56岁。双小腿红斑、结节、溃疡伴疼痛3个月。病史、临床表现结合组织病理学诊断为钙化防御。患者经治疗疼痛症状略改善,皮损无明显好转,2个月后失访。

骨化三醇联合西那卡塞治疗慢性肾衰竭并继发性甲状旁腺功能亢进症的疗效

目的观察骨化三醇联合西那卡塞治疗慢性肾衰竭(CRF)并继发性甲状旁腺功能亢进症(SHPT)的疗效。方法选取福建省泉州市第一医院肾内科2019年7月—2021年11月收治的82例CRF并SHPT患者,采用随机数字表法分为西那卡塞组与联合用药组,各41例。西那卡塞组予西那卡塞治疗,联合用药组在西那卡塞组基础上予骨化三醇治疗,2组均连续治疗3个月。对比2组临床疗效、治疗前后血生化指标[钙离子、磷离子、全段甲状旁腺素(iPTH)、转化生长因子-α(TGF-α)水平及NOD样受体家族蛋白3(NLRP3)表达量]及药品不良反应(ADR)发生率。结果联合用药组总有效率明显高于西那卡塞组(97.56%vs.82.93%,χ^(2)=4.986,P=0.026)。治疗3个月后,与治疗前比较,2组钙离子浓度升高,磷离子浓度和血清iPTH、TGF-α水平及NLRP3表达量降低,且联合用药组升高/降低幅度大于西那卡塞组(P<0.01)。西那卡塞组与联合用药组ADR总发生率比较,差异无统计学意义(12.20%vs.9.76%,χ^(2)=0.114,P=0.736)。结论骨化三醇联合西那卡塞治疗CRF并SHPT的临床疗效显著,可通过有效改善TGF-α水平、NLRP3表达量而抑制病情进展,改善钙磷代谢,且安全性较高。

阿法骨化醇冲击治疗对慢性肾衰竭长期血透患者继发性甲状旁腺功能亢进的疗效分析

目的探讨阿法骨化醇冲击治疗慢性肾衰竭(CRF)长期血液透析患者继发性甲状旁腺功能亢进患者的临床效果。方法选取2020年8月至2021年8月于聊城市东昌府人民医院接受治疗的60例CRF患者作为研究对象,随机分为观察组与对照组,每组30例。对照组予以常规治疗,观察组予以阿法骨化醇冲击治疗,比较两组治疗前后血钙(BC)、血磷(BP)、碱性磷酸酶(ALP)等实验室指标、不同时间点甲状旁腺激素(PTH)及并发症发生情况。结果治疗后,两组BC水平均高于治疗前,BP、ALP水平均低于治疗前,且观察组BC水平高于对照组,BP、ALP水平均低于对照组,差异有统计学意义(P<0.05)。两组PTH组间、时间比较差异有统计学意义(P<0.05),两组PTH交互比较差异无统计学意义。治疗前,两组PTH水平比较差异无统计学意义;治疗3、7、14 d,两组PTH水平均低于前一时间点,且观察组低于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义。结论阿法骨化醇冲击治疗CRF长期血液透析并发甲状旁腺功能亢进患者可有效控制BC、BP、ALP水平,通过降低PTH水平改善患者甲状旁腺功能,患者并发症发生率并未增加,值得临床推广应用。

Vertebral Brown Tumor in Childhood (Case Report)

One form of renal osteodystrophy secondary to chronic renal failure is the osteitis fibrosa cystica, which is the complication of secondary hyperparathyroidism. Osteitis fibrosa cystica is a histologically benign, tumor-like lesion of bones. Since early diagnosis and treatment of hyperparathyroidism is available nowadays, the development of osteitis fibrosa cystica has become rare. It can only be found in neglected cases and in those where the treatment of chronic renal failure is unsuccessful. We present the case of a boy, who developed osteitis fibrosa cystica as a complication of secondary hyperparathyroidism. Our article is the first to report a case about an osteitis fibrosa cystica found in a child’s vertebra and this tumor was the only one, which reached a size of approximately 10 × 15 × 15 cm. We present the CT films and X-ray pictures, the surgical solution and the results of the histological examination.

慢性肾功能衰竭继发甲状旁腺功能亢进的外科治疗

目的：探讨甲状旁腺全切除加前臂自体移植术治疗继发性甲状旁腺功能亢进的疗效。方法：1999年11 月～2005年4月，对15例继发性甲状旁腺功能亢进病人施行了上述治疗。结果：15例患者共切除增生性甲状旁腺52 枚。B 超对甲状旁腺的检出率为96． 2%。术后临床症状改善，血钙控制在正常范围内，术后第1天、1周、2周、3周和 3个月血全段甲状旁腺素(intact parathyroid hormone，iPTH)平均值分别为14． 0、 17． 8、 113． 7、 145． 0和148． 2ng/L。1例 术后4年移植物增生复发，切除后临床症状改善，无并发症。结论：甲状旁腺全切除加前臂自体移植术治疗继发性 甲状旁腺功能亢进是可行的，手术安全，近期疗效满意，其远期疗效有待进一步随访加以肯定。

骨化三醇治疗慢性肾功能衰竭患者继发甲状旁腺功能亢进的临床观察

目的:评价骨化三醇常规治疗和冲击治疗对慢性肾功能衰竭患者继发甲状旁腺功能亢进(SHPT)的疗效。方法:选择肾功能不全82例血液透析患者,血甲状旁腺激素(iPTH)水平>300pg/mL,随机分为冲击组和常规治疗组,结合临床服用不同剂量的骨化三醇,观察24周,检测治疗前后血iPTH及钙磷代谢相关指标。结果:与治疗前相比,冲击组、常规治疗组的钙,iPTH,ALP(碱性磷酸酶)的值与之前有明显差异(P<0.05);与治疗前相比,常规治疗组及冲击组治疗血磷均有所下降,无统计学差异。冲击治疗组与常规治疗组比较,在4周、8周、12周,两组间的iPTH有明显的统计学差异(P<0.05),24周时两组间iPTH无明显的统计学差异。两组的不良反应均较少。结论:骨化三醇用于慢性肾功能衰竭患者继发性甲旁亢临床效果安全确切,冲击疗法较常规治疗对降低iPTH的临床疗效更为显著。

骨化三醇冲击治疗血液透析患者继发性甲状旁腺功能亢进的疗效

目的研究骨化三醇治疗血液透析(HD)患者继发性甲状旁腺功能亢进(SHPT)的有效性和安全性。方法选择30例HD患者,血清甲状旁腺激素(iPTH)>300pg/ml,钙磷乘积<4.04mmol2/L2,根据血清iPTH的水平确定骨化三醇的治疗剂量,记录血钙、血磷、钙磷乘积、血iPTH的变化。结果观察治疗6个月后,iPTH水平显著降低(P<0.05),21例患者达到目标范围;治疗过程中有7例出现高磷血症,5例患者出现高钙血症,无1例发生持续性高钙血症,无1例钙磷乘积大于5.65mmol2/L2。结论骨化三醇冲击疗法可有效控制HD患者SHPT,且在SHPT的早期疗效更显著,安全性良好。

慢性肾衰患者PTH水平及相关因素的研究

目的 :探讨慢性肾衰患者的PTH水平及相关因素。方法 :采用放免法检测尿毒症患者的PTH水平及其与肾性骨病、高血压的关系 ,以及血液滤过和血液透析对尿毒症患者PTH水平的影响。结果 :尿毒症早期与透析患者的iPTH分别为 (12 0 .3± 6 3.5 )pg/ml、(2 75 .6± 2 5 6 .3) pg/ml,升高明显 ,但与血压无明显的相关性 ,FDF与HD患者的PTH水平无差异 ,根据PTH水平结合钙、磷、AKP基本可明确肾骨病的类型。结论 :尿毒症患者的PTH明显升高 ,长期HDF对尿毒症患者的PTH水平无影响 ,尿毒症患者的PTH水平对明确肾性骨病的类型非常有意义。

阿法骨化醇胶丸联合碳酸钙片治疗慢性肾衰继发甲状旁腺功能亢进的疗效观察

目的:观察阿法骨化醇胶丸联合碳酸钙片治疗慢性肾衰继发甲状旁腺功能亢进(SHPT)的疗效。方法:将55例慢性肾衰继发SHPT患者分为透析组(28例)和非透析组(27例),均在服用阿法骨化醇胶丸的同时加用碳酸钙片,连用3mo。观察治疗前、后血钙(Ca2+)、磷(P3-)、甲状旁腺激素(PTH)、碱性磷酸酶(AKP)、肌酐(Cr)的变化。结果:2组治疗后血Ca2+均明显升高(P<0.05),血PTH均明显下降(P<0.01)。结论:阿法骨化醇胶丸联合碳酸钙片治疗慢性肾衰继发SHPT早期患者安全、有效、经济。

全段甲状旁腺激素在继发性甲旁亢早期诊断中的意义

目的：探讨双位点免疫放射分析法（IRMA）检测血清全段甲状旁腺激素（intactPTH）在慢性肾衰继发性甲状旁腺机能亢进（SHPT）早期诊断中的意义。方法：采用德普公司生产的intactPTHIRMA药盒，检测118例慢性肾衰患者和67例健康人血清intactPTH和其它血生化指标，观察其中24例慢性肾衰患者髂骨活检不脱钙切片的病理学改变，并进行督组织形态计量学参数测量。结果：慢性肾衰早期钙磷代谢尚无明显异常时，血清intactPTH水平已升高，且与骨活检病理学改变一致，血清mintactPTH浓度与反映骨吸收、骨转换活跃程度的计量学参数骨吸收表面的百分率（TRS／TBS）呈正相关。结论：双位点IRMA测定血清intactPTH水平可用于早期诊断慢性肾衰继发性甲状旁腺机能亢进。

慢性肾衰致重症继发性甲状旁腺功能亢进的外科治疗(附10例报告)

目的：探讨甲状旁腺全切加前臂移植术治疗慢性肾衰致重症继发性甲状旁腺功能亢进的临床疗效。方法：对１９９５年１２月～２００１年９月经此方法治疗的１０例患者资料进行回顾性分析，并从定位诊断、手术适应证、围手术期处理等方面进行讨论。结果：１０例患者共切除增生的甲状旁腺３８枚，全部移植腺体成活，临床症状改善，各项化验结果逐步恢复正常。结论：对内科治疗无效的重症继发性甲状旁腺功能亢进进行甲状旁腺全切加前臂移植是一种安全、有效的治疗方法。

^(99m)Tc-MIBI SPECT/CT断层融合显像在继发性甲状旁腺功能亢进症诊断中的价值

目的研究SPECT/CT断层融合在继发性甲状旁腺功能亢进症(SHPT)中的诊断价值,初步探讨影响甲状旁腺显像的因素。方法 SHPT患者35例,采用双时相法显像,5 min、30 min早期显像及1 h、2 h延迟平面显像,2 h后平面显像后随即行颈胸部99mTc-MIBI SPECT/CT同机融合显像。平面显像与静态显像相比较35例,术后病理相比较29例,并结合患者的临床表现及实验室指标进行统计分析,对平面和SPECT/CT显像的诊断阳性率行χ2检验。结果平面显像诊断阳性率为71.43%(25/35),断层阳性率91.43%(32/35)。平面显像和SPECT/CT对继发性甲状旁腺功能亢进诊断的差异有统计学意义(χ2=5.1429,P<0.05)。结论 SPECT/CT显像比面显像更能有效的甄别继发性甲状旁腺的基础上增加了核素融合和CT诊断信息,可以显示病变部位的更细微的定位结构,明显提高了对甲状旁腺病变诊断的阳性率。