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Aktuelle Indikation und operative Strategie beim renalen Hyperparathyreoidismus

Current indications and operative strategy for renal hyperparathyroidism

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Zusammenfassung

Hintergrund

Der renale Hyperparathyreoidismus resultiert aus pathophysiologischen Veränderungen, welche durch eine terminale Niereninsuffizienz ausgelöst und unterhalten werden. Die chirurgische Therapie umfasst verschiedene Resektionsstrategien.

Ziel der Arbeit (Fragestellung)

Die Arbeit soll die Indikationen sowie Techniken und Resektionsstrategien zur chirurgischen Sanierung des renalen Hyperparathyreoidismus aufzeigen.

Material und Methoden

Nationale und internationale Leitlinien zur chirurgischen Therapie des renalen Hyperparathyreoidismus wurden analysiert. Weiterhin wurden eigene Erfahrungen aus der Praxis in den Artikel integriert.

Ergebnisse

Während die Indikation zur Operation nach den Leitlinien der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK) bei klinischer Beeinträchtigung und einem medikamentös nicht beherrschbaren renalen Hyperparathyreoidismus gegeben ist, richten sich internationale Leitlinien darüber hinaus nach dem absoluten Parathormonwert.

Diskussion

Eine individuelle Beratung des Patienten ist im Falle des renalen Hyperparathyreoidismus notwendig, um – unter Einbezug des individuellen Risikoprofils und weiterer Therapieperspektiven, einschließlich einer Nierentransplantation – den richtigen Zeitpunkt zur chirurgischen Sanierung sowie die angewandte Operationstechnik festzulegen.

Abstract

Background

Renal hyperparathyroidism results from pathophysiologic changes induced and maintained by terminal renal failure. Surgical treatment is possible using various resection strategies.

Aim of the work (research question)

The aim of this work is to illustrate the indications, techniques and resection strategies for surgical treatment of renal hyperparathyroidism.

Material and methods

National and international guidelines regarding the surgical treatment of renal hyperparathyroidism were analyzed. Furthermore, our own practical experience was integrated into the article.

Results

While the indications for surgery according to the Surgical Working Group Endocrinology (CAEK) guidelines are given in cases of clinical impairment and renal hyperparathyroidism that cannot be controlled by medication, international guidelines additionally refer to the absolute parathyroid hormone level for deciding for surgery.

Discussion

Individual patient consultation is necessary in the case of renal hyperparathyroidism in order to determine the right time for surgical treatment as well as the most suitable surgical technique, taking into account the individual risk profile and other therapeutic perspectives, including renal transplantation.

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Authors and Affiliations

  1. Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    Julia I. Staubitz &  Thomas J. Musholt

Authors
  1. Julia I. Staubitz
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  2. Thomas J. Musholt
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Corresponding author

Correspondence to Thomas J. Musholt.

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Interessenkonflikt

J.I. Staubitz und T.J. Musholt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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D.K. Bartsch, Marburg

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Staubitz, J.I., Musholt, T.J. Aktuelle Indikation und operative Strategie beim renalen Hyperparathyreoidismus. Chirurgie 94, 602–607 (2023). https://doi.org/10.1007/s00104-023-01878-x

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  • DOI: https://doi.org/10.1007/s00104-023-01878-x

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