{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:58:44Z","timestamp":1791536324106,"version":"4.3.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Tertiary hyperparathyroidism (3HPT) is defined as a condition of excessive autonomous excretion of intact parathyroid hormone (iPTH) with persistent hypercalcemia (&amp;gt;10.5 mg\/dL) that lasts for more than 12 months after a successful kidney transplantation, in the context of a long course secondary hyperparathyroidism (2HPT). The chronic high levels of iPTH cause a worsening of graft function, accompanied by systemic symptoms of hypercalcemia. The only curative therapy is parathyroidectomy (PTX). It remains unclear whether total parathyroidectomy with autotransplantation (TPTX-AT) or subtotal parathyroidectomy (SPTX) lead to better outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim of this retrospective, single-institution cohort study is to evaluate the rate of persistent or recurrent disease and postoperative calcium\/iPTH disturbances in patients treated with TPTX-AT or SPTX for 3HPT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A single-center retrospective analysis of 3HPT patients submitted to TPTX-AT or SPTX between 2007\u20132020 with at least 24 months follow-up was conducted. The outcome parameters included persistence\/recurrence of disease, incidence of transitory hypocalcemia, and temporary\/permanent hypoparathyroidism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A cohort of 52 patients was analyzed and divided in two groups: 38 (73%) were submitted for TPTX-AT, and 14 patients (27%) were submitted for SPTX. The TPTX-AT population showed lower plasmatic calcium concentrations compared with the SPTX group during the entire follow-up period (p&amp;lt;0.001). There were eight cases (21%) of transitory hypocalcemia in the TPTX-AT group and none in the SPTX group, with p=0.065. Two cases (5%) of temporary hypoparathyroidism occurred in the TPTX-AT group and none in the SPTX group, with p= 0.530. There were no cases of permanent hypoparathyroidism and no cases of persistent disease. No statistical difference was assessed for the recurrence of 3HPT between the TPTX-AT group and the SPTX group (N=1, 3% vs N=1, 7%) (p=0.470).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>No significative difference was registered between the TPTX-AT and SPTX groups in terms of persistence\/recurrence of disease, incidence of transitory hypocalcemia, and temporary\/permanent hypoparathyroidism. Mean calcium levels iPTH values were statistically lower among the TPTX-AT group compared with the SPTX group while remaining always in the range of normality.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2023.1226917","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T05:57:16Z","timestamp":1698991036000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Surgical treatment of tertiary hyperparathyroidism: does one fit for all?"],"prefix":"10.3389","volume":"14","author":[{"given":"Claudio","family":"Casella","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Guarneri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Campanile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Adhoute","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier Paolo","family":"Gelera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Morandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.surg.2021.03.067","article-title":"Prevalence and risk factors for tertiary hyperparathyroidism in kidney transplant recipients","volume":"171","author":"Sutton","year":"2022","journal-title":"Surgery"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0230130","article-title":"Epidemiology and management of parathyroid gland disorders in Spain over 15 years: A retrospective multicentre analysis","volume":"15","author":"Darb\u00e0","year":"2020","journal-title":"PloS One"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.7417\/CT.2021.2322","article-title":"Tertiary hyperparathyroidism: a review","volume":"172","author":"Palumbo","year":"2021","journal-title":"Clin Ter"},{"key":"B4","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1097\/00000658-199806000-00011","article-title":"Operative treatment of tertiary hyperparathyroidism: a single-center experience","volume":"227","author":"Kerby","year":"1998","journal-title":"Ann Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1161\/01.RES.0000141775.67189.98","article-title":"Pathophysiology of vascular calcification in chronic kidney disease","volume":"95","author":"Moe","year":"2004","journal-title":"Circ Res"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.2147\/IJNRD.S191156","article-title":"Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD): current perspectives","volume":"12","author":"Waziri","year":"2019","journal-title":"Int J Nephrol Renovasc Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1056\/NEJM197308232890804","article-title":"Hypercalcemia after renal transplantation. 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