[Surgical treatment of secondary hyperparathyroidism: a systematic review of the literature].

Felipe Ferraz Magnabosco, Marcos Roberto Tavares, Fábio Luiz de Menezes Montenegro
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引用次数: 13

Abstract

Secondary hyperparathyroidism (HPT) has a high prevalence in renal patients. Secondary HPT results from disturbances in mineral homeostasis, particularly calcium, which stimulates the parathyroid glands, increasing the secretion of parathyroid hormone (PTH). Prolonged stimulation can lead to autonomy in parathyroid function. Initial treatment is clinical, but parathyroidectomy (PTx) may be required. PTx can be subtotal or total followed or not followed by parathyroid tissue autograft. We compared the indications and results of these strategies as shown in the literature through a systematic literature review on surgical treatment of secondary HPT presented in MedLine and LILACS from January 2008 to March 2014. The search terms were: hyperparathyroidism; secondary hyperparathyroidism; parathyroidectomy and parathyroid glands, restricted to research only in humans, articles available in electronic media, published in Portuguese, Spanish, English or French. We selected 49 articles. Subtotal and total PTx followed by parathyroid tissue autograft were the most used techniques, without consensus on the most effective surgical procedure, although there was a preference for the latter. The choice depends on surgeon's experience. There was consensus on the need to identify all parathyroid glands and cryopreservation of parathyroid tissue whenever possible to graft if hypoparathyroidism arise. Imaging studies may be useful, especially in recurrences. Alternative treatments of secondary HPT, both interventional and conservative, require further study.

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[继发性甲状旁腺功能亢进的手术治疗:文献系统综述]。
继发性甲状旁腺功能亢进(HPT)在肾脏患者中有很高的患病率。继发性HPT是由矿物质稳态紊乱引起的,尤其是钙,它刺激甲状旁腺,增加甲状旁腺激素(PTH)的分泌。长时间的刺激可导致甲状旁腺功能的自主。最初的治疗是临床治疗,但可能需要甲状旁腺切除术(PTx)。自体甲状旁腺组织移植可以是次全移植,也可以是全移植,也可以不移植。我们通过对2008年1月至2014年3月在MedLine和LILACS上发表的关于继发性HPT手术治疗的系统文献综述,比较了这些策略的适应症和结果。搜索词是:甲状旁腺功能亢进;继发性甲状旁腺功能亢进;甲状旁腺切除术和甲状旁腺,仅限于人类研究,文章可在电子媒体上获得,以葡萄牙语、西班牙语、英语或法语出版。我们选择了49篇文章。小总PTx和总PTx之后自体甲状旁腺组织移植是最常用的技术,对于最有效的手术方法尚未达成共识,尽管人们更倾向于后者。选择取决于外科医生的经验。人们一致认为,如果出现甲状旁腺功能减退,需要识别所有甲状旁腺,并在可能的情况下冷冻保存甲状旁腺组织以进行移植。影像学检查可能是有用的,特别是在复发时。继发性HPT的其他治疗方法,包括介入性和保守性,都需要进一步研究。
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[Multiple endocrine neoplasia type 2]. [Thyroid hormone resistance syndrome]. A case of thyroid hormone resistance: a rare mutation. [Giant metastasis of thyroid papillar carcinoma]. Angiotensin-II induced insulin resistance.
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