Radioguided Parathyroidectomy for Recurrent Hyperparathyroidism : an effective multi-institutional approach at the University of Messina Hospital

Secondary hyperparathyroidism (SHPT) is a common complication of chronic kidney disease (CKD). The progressive decline in renal function, in fact, leads to the alteration of the metabolism of calcium (Ca), phosphorus (P) and vitamin D. Difference of other forms of hyperparathyroidism, renal SHPT has many pathogenetic peculiarities, which have been only in part clarified. Furthermore, in the long course of CKD, SHPT sometimes transforms into a hypercalcemic condition resembling the autonomous form of hyperparathyroidism (tertiary hyperparathyroidism; THP). The clinical consequences of SHPT in CKD patients are manifold, encompassing not only bone and mineral disorders, but also other metabolic and organic changes which frequently burden these patients. Although the medical therapeutic tools have substantially increased in number and improved in their efficacy in recent decades, we have as yet no demonstration of a clear benefit regarding the major clinical outcomes. Furthermore, some of these patients still require a surgical approach. Herein we discussed the clinical management and surgical treatment for a case of a recurrent secondary hyperparathyroidism.