Rodríguez-Ortiz María E, Pendón-Ruiz de Mier María V, Rodríguez Mariano
Maimónides Institute for Biomedical Research (IMIBIC), Córdoba, Spain.
Reina Sofía University Hospital, Córdoba, Spain.
Semin Dial. 2019 Sep;32(5):444-451. doi: 10.1111/sdi.12772. Epub 2019 Jan 17.
Secondary hyperparathyroidism, characterized by increased PTH synthesis and secretion, is often seen in advanced stages of chronic kidney disease. Excessive proliferation of parathyroid cells leads to the development of diffuse hyperplasia that subsequently progresses to nodular histology. Refractory hyperparathyroidism occurs when parathyroid glands fail to respond to medical therapy. Parathyroidectomy (PTX), surgical resection of parathyroid glands, is usually performed in cases of persistent serum levels of PTH above 1000 pg/mL associated with hypercalcemia or when hyperparathyroidism is refractory to conservative therapy. Parathyroidectomy can be carried out using different procedures: subtotal PTX or total PTX with or without parathyroid autotransplantation. Parathyroid surgery may have undesirable consequences due to PTH oversuppression, such as the development of adynamic bone disease; hungry bone syndrome is quite common after this surgery. However, PTX improves survival and parameters of mineral metabolism. Parathyroidectomy needs to be considered in those patients with severe hyperparathyroidism with a poor response to pharmacological treatment and with distinct undesirable effects of PTH on bone and mineral metabolism parameters.
继发性甲状旁腺功能亢进的特征是甲状旁腺激素（PTH）合成和分泌增加，常见于慢性肾病晚期。甲状旁腺细胞过度增殖会导致弥漫性增生，随后发展为结节性组织学改变。当甲状旁腺对药物治疗无反应时，就会发生难治性甲状旁腺功能亢进。甲状旁腺切除术（PTX），即手术切除甲状旁腺，通常在血清PTH持续高于1000 pg/mL且伴有高钙血症，或甲状旁腺功能亢进对保守治疗无效的情况下进行。甲状旁腺切除术可采用不同的手术方式：次全甲状旁腺切除术或全甲状旁腺切除术，可伴或不伴甲状旁腺自体移植。甲状旁腺手术可能因PTH过度抑制而产生不良后果，如动力缺失性骨病的发生；饥饿骨综合征在该手术后相当常见。然而，甲状旁腺切除术可提高生存率并改善矿物质代谢指标。对于那些严重甲状旁腺功能亢进且对药物治疗反应不佳、PTH对骨和矿物质代谢指标有明显不良影响的患者，需要考虑进行甲状旁腺切除术。
