Controversy and progress in parathyroidectomy for the treatment of secondary hyperparathyroidism

Abstract

Secondary hyperparathyroidism is one of common complications of long-term dialysis patients. Although medical treatment schemes such as calcimimetics and vitamin D analogues can be selected, patients refractory to drug treatment can still refer to parathyroidectomy as a treatment choice. At present, the surgical treatment include subtotal parathyroidectomy, total parathyroidectomy with or without auto-transplantation and purge parathyroidectomy. Because the etiology of this disease is related to hyperplasia of parathyroid tissue stimulated with metabolic disorder of calcium, phosphorus and vitamin D in dialysis patients, the course of disease and target indexes of surgical treatment might still be difficult to control, and there still lies controversies in surgical therapeutic strategy. However, with updating of clinical data, the emergence of new concepts and the introduction of new technologies, reasonable drug selection and appropriate timing of surgical intervention will further improve the treatment efficacy and safety.

Keywords

• |secondary hyperparathyroidism|parathyroidectomy|metabolic disorder of calcium and phosphorus