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Long-term results after surgical treatment of renal hyperparathyroidism when fewer than four glands are identified at operation.

BACKGROUND
When fewer than four parathyroid glands are discovered during cervical exploration in cases of renal hyperparathyroidism, some have suggested that the glands could be resected and that no parathyroid tissue should be grafted. The aim of the present study was to evaluate this approach. Indeed, no detailed follow-up of such patients has been reported so far.


STUDY DESIGN
Between September 1979 and July 1995, 157 patients underwent a cervical exploration for renal hyperparathyroidism in our department. In 23 cases, fewer than four parathyroid glands were found. The present study reports the results of 16 of these patients who did not undergo autotransplantation with parathyroid tissue after resection of all identified glands.


RESULTS
At their last visit, four patients had normal blood levels of intact parathyroid hormone 14 to 71 months (median 60 months) after parathyroidectomy. The parathyroid hormone was not detectable in 2 patients at 16 and 76 months after operation. It was elevated in the 10 remaining patients, but the disease required no treatment or could be controlled medically in 7 patients with a follow-up ranging from 12 to 100 months (median 33 months). Two patients needed reoperation, one at 14 and one at 45 months after the first operation. An ectopic gland was found in both cases. The last patient refused further surgical treatment and died after 13 months.


CONCLUSIONS
In most cases, autotransplantation of parathyroid tissue is not necessary when fewer than four glands are identified during parathyroidectomy. When grafting was omitted, 14 of 16 patients had normal or elevated blood levels of intact parathyroid hormone 10 to 100 months after parathyroidectomy (median 45 months). However, in two patients, intact parathyroid hormone was persistently undetectable for 16 to 76 months. This suggests that parathyroid tissue should be cryopreserved for delayed autotransplantation when the surgeon chooses not to graft parathyroid tissue.