Is There an Optimal Time for Parathyroidectomy in Patients with Secondary Hyperparathyroidism?
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In contrast to primary hyperparathyroidism (HPT), secondary HPT is characterized by increased production of parathyroid hormone (PTH) as a response to external stimuli, as opposed to an intrinsic abnormality of the parathyroid gland(s). Most commonly this occurs as a result of chronic kidney disease, and medical management is guided by the severity of renal disease with the goal of minimizing cardiovascular and skeletal-related morbidity and mortality. In 1971, Richard Wilson and colleagues first reported experience with subtotal parathyroidectomy in patients with severe secondary hyperparathyroidism and renal failure, intended to delay progression of osteitis fibrosis cystica in patients. Since that time, parathyroidectomy has been shown to result in durable decreases in serum PTH, phosphorus, and calcium levels, with decreases in patient morbidity and mortality.
Sparked by identification of the calcium-sensing receptor (CaSR) in the 1990s, development of a new class of drugs,...