Surgical treatment of secondary hyperparathyroidism in children with chronic kidney disease. Experience in 19 patients
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Abstract
Objectives
Secondary hyperparathyroidism (sHPT) is an important contributor to bone disease and cardiovascular calcifications in children with chronic kidney disease (CKD). When conservative measures are ineffective, parathyroidectomy is indicated. The aim of our study was to evaluate the efficacy and safety of subtotal parathyroidectomy (sPTX) in pediatric and adolescent patients, and to provide a rationale for considering this aggressive treatment in CKD patients with uncontrolled sHPT.
Methods
We retrospectively analyzed the medical records of 19 pediatric CKD patients on dialysis with refractory sHPT who underwent sPTX at our institution between 2010 and 2020. All patients had clinical, radiological, and biochemical signs of renal osteodystrophy.
Results
One year after sPTX, parathyroid hormone (PTH) levels (median and interquartile range (IQR)) dropped from 2073 (1339–2484) to 164 (93–252) pg/mL (p=0.0001), alkaline phosphatase (ALP) levels from 1166 (764–2373) to 410 (126–421) IU/L (p=0.002), and the mean (±SDS) calcium-phosphate (Ca*P) product from 51±11 to 41±13 mg2/dL2 (p=0.07). Postoperatively, all patients presented with severe hungry bone syndrome (HBS) and required intravenous and oral calcium and calcitriol supplementation. None of them had other postoperative complication. Histological findings had a good correlation with preoperative parathyroid ultrasound imaging (n: 15) in 100 % and with technetium-99m (99mTc) sestamibi scintigraphy (n: 15) in 86.6 %. Clinical and radiological signs of bone disease improved in all patients.
Conclusions
Pediatric sPTX is effective and safe to control sHPT and calcium-phosphate metabolism in children with CKD on dialysis and may mitigate irreversible bone deformities and progression of cardiovascular disease.
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Research ethics: Not applicable.
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Informed consent: The informed consent for surgery for all patients includes authorization for potential publications.
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Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Research funding: None declared.
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Data availability: The raw data can be obtained on request from the corresponding author.
References
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Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/jpem-2023-0492).
© 2024 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
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- Early change of retinal nerve fiber layer in children with type 1 diabetes mellitus in northern China
- Investigating the connection among thyroid function, sensitivity to thyroid hormones, and metabolic syndrome in euthyroid children and adolescents affected by type 1 diabetes
- Surgical treatment of secondary hyperparathyroidism in children with chronic kidney disease. Experience in 19 patients
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- Late diagnosis of the X-linked MCT8 deficiency (Allan–Herndon–Dudley syndrome) in a teenage girl with primary ovarian insufficiency
- An infant developing hypercalcemia and hypophosphatemia due to the use of exclusively almond milk
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Articles in the same Issue
- Frontmatter
- Review
- The effect of GnRH analog treatment on BMI in children treated for precocious puberty: a systematic review and meta-analysis
- Original Articles
- Association of hepatokines with markers of endothelial dysfunction and vascular reactivity in obese adolescents
- Evaluation of cardiac electrophysiological features in patients with premature adrenarche
- Growth hormone treatment in children with short stature: impact of the diagnosis on parents
- Ovarian reserve and fertility parameters in post-pubertal females with congenital adrenal hyperplasia: a case-control study
- Early change of retinal nerve fiber layer in children with type 1 diabetes mellitus in northern China
- Investigating the connection among thyroid function, sensitivity to thyroid hormones, and metabolic syndrome in euthyroid children and adolescents affected by type 1 diabetes
- Surgical treatment of secondary hyperparathyroidism in children with chronic kidney disease. Experience in 19 patients
- Short Communication
- Decline in case rates of youth onset type 2 diabetes in year three of the COVID-19 pandemic
- Letters to the Editor
- The effect of phenylketonuria on family quality of life
- Struggle for the future health of adolescent patients with phenylketonuria and parents with a sick child due to the economic crisis
- Case Reports
- A new onset drug induced diabetes mellitus presenting with diabetic ketoacidosis in a child undergoing treatment for B cell acute lymphoblastic leukemia. A case report and review of literature
- Late diagnosis of the X-linked MCT8 deficiency (Allan–Herndon–Dudley syndrome) in a teenage girl with primary ovarian insufficiency
- An infant developing hypercalcemia and hypophosphatemia due to the use of exclusively almond milk
- New data supporting that early diagnosis and treatment are possible and necessary in intracellular cobalamin depletion: the case of transcobalamin II deficiency
