TISSUE SELECTION WITH OR WITHOUT STEREOMICROSCOPY IN SURGICAL TREATMENT FOR RENAL HYPERPARATHYROIDISM

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 199-237-Disorders of Parathyroid Hormone & Calcium Homeostasis
Translational
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-216
Monique Nakayama Ohe*1, Rodrigo Oliveira Santos1, Murilo Catafesta Neves2, Aluizio Barbosa Carvalho2, Ilda Sizue Kunii2, Marcio Abrahao2, Onivaldo Cervantes2, Marise Lazaretti-Castro3 and Jose Gilberto Vieira4
1EPM-UNIFESP, Sao Paulo, Brazil, 2EPM-UNIFESP, 3UNIFESP, Sao Paulo SP, Brazil, 4Laboratorio Fleury, Sao Paulo, Brazil
BACKGROUND: Several methods have been proposed to improve success rates in surgical treatment of renal hyperparathyroidism. We evaluate stereomicroscopy in parathyroid tissue selection in total parathyroidectomy with presternal autotransplantation in patients with secondary/tertiary hyperparathyroidism.

PATIENTS/METHODS: 119 renal patients underwent total parathyroidectomy with intramuscular presternal autotransplantation (AT) from 04/2000 to 10/2009 at Hospital São Paulo/Hospital do Rim EPM-UNIFESP, São Paulo-Brazil. Patients were divided in: G1 comprised 67 patients operated on from 04/2000 to 05/2005 whose parathyroid tissue selection for AT was performed based on macroscopic observation; G2 comprised 52 patients operated on from 03/2008 to 10/2009 whose parathyroid tissue selection was performed using a Leica StereoZoom S8APO Stereomicroscope (magnification10x-80x), based mainly on the search for the presence of stromal fat cells. Patients were classified in secondary (SHPT) and tertiary hyperparathyroidism (THPT). In SHPT group we included patients under dialysis treatment; THPT group included renal grafted ones. Follow-up from12-36 months, with intra-operative PTH performed in 100/119(84%) patients (Elecsys-1010-System/Roche, Mannheim, Germany).

RESULTS: Data on average. G1–67 patients (39 SHPT: 25f/14m, 39.6yrs, 7.8yrs under dialysis treatment; 28 THPT: 14f/14m, 44yrs, 6.5yrs under dialysis treatment, 2.8yrs after renal-graft). G2–52 patients (29 SHPT: (11f/18m, 50.3yrs, 7.9yrs under dialysis treatment; 23 THPT: 13f/10m, 44.4yrs, 6.6yrs under dialysis treatment, 3.5yrs after renal-graft). SHPT patients from G2 presented preoperative serum calcium higher than those in G1 (t test;P<0.05), suggesting a more severe disease. Definitive hypoparathyroidism was observed in 7/119 (5.8%) (4 in G1 and 3 in G2). Graft-dependent recurrence was observed in 4 patients, 2 in each group. All graft-dependent recurrences were observed in dialysis patients, none in kidney-grafted ones.

CONCLUSION: Stereomicroscopy in renal hyperparathyroidism surgical treatment may be a useful tool to standardize parathyroid tissue selection for AT. The more severe disease observed in SHPT in G2 may be the explanation for the finding of similar recurrence in both groups. Continuous exposition of the parathyroid grafted tissue to uremic environment may be the main driver for tumor recurrence in patients under long-term dialysis treatment.

Nothing to Disclose: MNO, ROS, MCN, ABC, ISK, MA, OC, ML, JGV

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm