PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Parathyroidectomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMed1982

Parathyroid surgery in chronic renal insufficiency. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation to the forearm.

During the period 1970 to 1980 48 parathyroidectomies were performed in 46 patients with chronic renal insufficiency. Thirty patients underwent 31 subtotal parathyroidectomies and 17 patients underwent total parathyroidectomy with parathyroid autotransplantation to the forearm. Ten patients were on conservative renal treatment, 26 were on chronic haemodialysis and 12 had functioning kidney transplants at the time of parathyroid surgery. The indication for parathyroidectomy were clinical symptoms such as pruritus, bone and joint pain, neuromuscular disorders and radiological skeletal abnormalities pointing to hyperparathyroidism (HPT). Hypercalcaemia was present in 38 patients. The clinical symptoms and radiological findings were favourably affected by parathyroid surgery but vascular calcification was not affected by the operation in any of the patients. Normocalcaemia was achieved after surgery in all patients except one, who had residual parathyroid tissue in the neck. Vitamin D substitution was required in about 30% of the patients regardless of the type of operation that was performed. Recurrent HPT occurred in 9% with similar rates after both types of surgery. However, recurrence was more easily managed after a total parathyroidectomy with autotransplantation to the forearm than after a subtotal parathyroidectomy.

Adolescent↗
PubMedDate not supplied

Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: a randomized trial.

In a randomized study subtotal parathyroidectomy (sPTX) was compared with total parathyroidectomy and autotransplantation of fresh tissue (PTX + AT) in 40 patients with severe secondary hyperparathyroidism (HPT). After surgery both groups were followed at 19 +/- 6 months (PTX + AT) and 19 +/- 7 months (sPTX) and at 43 +/- 9 months (PTX + AT) and 40 +/- 7 months (sPTX). There were 17 patients alive in each group at the time of the second follow-up. After sPTX, 2 patients required re-operation because of recurrent disease originating from the remaining parathyroid gland in the neck and another 2 patients were hypercalcemic at follow-up. After PTX + AT both serum calcium and alkaline phosphatase normalized significantly more often (p less than 0.03) than after sPTX. Re-operations were not required in this group. Radiological signs also improved significantly more after PTX + AT, as did clinical signs like pruritus (p less than 0.005) and muscle weakness (p less than 0.04). These results and the fact that in recurrent disease a re-operation at the autograft in the forearm is simpler than a re-operation in the neck, lead to the recommendation that PTX + AT should be considered as the method of choice in the surgical treatment of secondary HPT.

Adult↗
PubMed1992

Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients.

A retrospective study was performed in chronic hemodialysis patients comparing total parathyroidectomy (PTX) followed by immediate autografting (IA) (total PTX+IA) with subtotal parathyroidectomy (subtotal PTX). One hundred six patients with severe, uncontrolled hyperparathyroidism were referred to this center and underwent surgery during the period from 1980 to 1990. Long-term follow-up after PTX was available in 49 of them: 28 patients had total PTX+IA and 21 had subtotal PTX. The two surgical methods were evaluated with respect to preoperative severity of hyperparathyroidism, immediate postoperative results, and long-term parathyroid status, as evaluated by an RIA measuring intact immunoreactive parathyroid hormone (intact iPTH; normal values, 15 to 65 pg/mL). The initial degree of hyperparathyroidism was comparable in the two groups. An excellent short-term control of hyperparathyroidism was achieved in the great majority (95%) of patients with either surgical procedure. However, long-term normalization of parathyroid gland activity was achieved in only one third of patients whereas 33% had elevated intact iPTH levels (> 130 pg/mL; i.e., higher than twice the upper range of normal) and 32% had low intact iPTH levels (< 15 pg/mL), consistent with permanent hypoparathyroidism. No difference was found in the immediate failure rates: 0 of 28 cases after total PTX+IA compared with 2 of 21 cases after subtotal PTX. Similarly, long-term intact iPTH levels were comparable: 400 +/- 105 versus 212 +/- 82 pg/mL (mean +/- SE; P = not significant). Interestingly, long-term serum intact iPTH levels were higher in patients with nodular (N = 18) than with diffusely (N = 26) hyperplastic glands: 556 +/- 146 versus 126 +/- 52 pg/mL (P < 0.001) and recurrence of hyperparathyroidism was more frequent with nodular hyperplasia (11 of 18) than with diffuse hyperplasia (4 of 26) (P < 0.02). In conclusion, although excellent short-term results were obtained with both procedures, satisfactory long-term control of parathyroid gland function was achieved in only one third of the patients, the other two third remaining either hypoparathyroid or developing recurrent hyperparathyroidism. Last, the histological subtype of parathyroid glands was partially predictive of the recurrence of hyperparathyroidism.

Adult↗
PubMed1991

[Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation in secondary hyperparathyroidism. A randomized study].

In this randomised study subtotal parathyroidectomy (PTX) is being compared with total parathyroidectomy including autotransplantation (PTX + AT) in 40 patients with secondary hyperparathyroidism. Both groups were followed up twice, first 19 +/- 6 months (PTX + AT) respectively 19 +/- 7 months (subtotal PTX) and secondly 43 +/- 9 respectively 40 +/- 7 months after surgery. In each group there were 17 patients alive at the time of the second postoperative follow-up. In the meantime 2 patients with subtotal PTX required reoperation because of recurrences originating from the remaining parathyroid tissue, another 2 patients of this group were hypercalcaemic. After PTX + AT serum-calcium normalized significantly more often (p less than 0.03), a corresponding result was seen in alkaline phosphatase. Reoperation was not required in this group. Also radiological alterations reformed significantly more often after PTX + AT, so did clinical signs like pruritus (p less than 0.005) and muscular weakness (p less than 0.04). Considering these results and the fact that in case of recidive a reoperation of the autograft in the forearm is much easier to perform than a reoperation in the neck, PTX + AT is recommended as method of choice in surgical treatment of sHPT.

Adult↗
PubMed1985

Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism.

A retrospective review of patients treated for secondary hyperparathyroidism by total parathyroidectomy with parathyroid autotransplantation (tPTX) and subtotal parathyroidectomy (sPTX) is presented. Ten patients underwent tPTX, and 22 patients underwent sPTX between 1977 and 1982. Hypocalcemia and complications of its treatment were a problem in the tPTX patients. One patient in the tPTX group and no patients in the sPTX group have required reoperation for recurrence. Both procedures were highly successful in relieving symptoms of secondary hyperparathyroidism and in reversing renal osteodystrophy. The authors believe that sPTX is a proven, effective operation and the operative treatment of choice for secondary hyperparathyroidism.

Adult↗
PubMed1987

Increased leukotriene B4 synthesis in patients with primary hyperparathyroidism is normalized after parathyroidectomy: a study comparing parathyroidectomy to thyroid adenomectomy.

Synthesis of leukotriene B4 (LTB4) upon stimulation of peripheral blood samples with the calcium ionophore A 23187 was studied in patients with primary hyperparathyroidism who underwent parathyroidectomy. Preoperatively, an increased LTB4 concentration of 1.76 +/- 0.19 ng/ml plasma was found, vs. 0.95 +/- 0.28 ng/ml in healthy individuals. On the fourth day after operation, the LTB4 concentration was almost normalized, reaching 1.25 +/- 0.23 ng/ml plasma. At the same time, mean serum calcium levels were reduced from 6.1 +/- 0.6 meq/liter before operation to 4.53 +/- 0.28 meq/liter after operation. In a control group, euthyroid patients with thyroid adenomas who underwent adenomectomy had normal LTB4 levels before operation (0.84 +/- 0.11 ng/ml) and did not show significant changes in LTB4-synthesizing capacity. The results indicate that synthesis of LTB4 in vivo may depend in part on factors related to serum calcium concentration or calcium metabolism.

Adenoma↗
PubMed1983

Effects of parathyroidectomy and vitamin D on fracture healing. Fracture biomechanics in rats after parathyroidectomy and treatment with 1,25-dihydroxycholecalciferol.

Fracture healing was studied in male, adult Sprague-Dawley rats. Closed bilateral tibial fractures were observed to be clinically stable after 3 weeks. Parathyroidectomy (PTX) resulted in impaired fracture healing and several delayed unions. Fracture tensile strength, elastic stiffness and failure energy were significantly lower at the beginning of the healing period compared to that of control fracture rats. Treatment with low doses (60 ng/kg/day) of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) increased early fracture bone formation and mineralization. However, these events did not result in a corresponding increase of tensile strength or failure energy compared with that of the controls. Increased bone turnover seemed to be the dominant characteristic and resulted in early resorption of periosteal callus. Toward the end of the healing period, fracture strength measured as tensile strength and failure energy actually decreased compared to that of the control rats. Elastic stiffness initially rose above control values due to increased mineralization, but declined later to control values.

Animals↗
PubMed1990

[Hyperparathyroidism in patients with chronic renal failure: subtotal parathyroidectomy or total parathyroidectomy with autotransplantation? Experience with 121 cases].

From 1973 to 1988 121 patients with chronic renal failure underwent parathyroidectomy (PTX) for secondary hyperparathyroidism. The surgical decision was made upon clinical and/or radiological signs and symptoms. Two kinds of operation were performed: Subtotal PTX 87 cases; Total PTX + parathyroid autograft 34 cases. Post-operative results are discussed. For all cases, the authors emphasize: the need of transcervical thymectomy (ectopic supernumerary gland = 17.3%); the need of routine cryopreservation. Subtotal PTX should be the routine operation. Total PTX with autograft is elicited when a combined thyroidectomy is performed, if parathyroid remnant's blood supply is questionable and in case of recurrent Secondary HPT.

Adolescent↗
PubMed1985

Parathyroidectomy in chronic renal failure.

In order to establish whether parathyroidectomy altered the natural history of ectopic calcification in patients with renal failure we undertook a detailed analysis of 62 patients with hyperparathyroidism secondary to chronic renal failure who were submitted to parathyroidectomy. Biochemical data (61 patients) and radiological skeletal surveys (42 patients) were studied before and after parathyroidectomy. Transiliac bone biopsies were obtained at (or some time in the previous six months before) parathyroidectomy in 30 and in 36 patients after surgery. Paired bone biopsies were available from 17 of these patients. In the majority of patients secondary hyperparathyroidism was controlled after parathyroidectomy although in seven patients (11 per cent), who underwent subtotal parathyroidectomy, it relapsed after initial improvement. Non-visceral soft tissue calcification disappeared or decreased in 60 per cent of the patients after parathyroidectomy. However, despite marked improvement in subperiosteal erosions and histological osteitis fibrosa, with significant reductions in iPTH and Ca X P product after parathyroidectomy, small peripheral arterial calcification developed or progressed in 56 per cent of the patients. Histological osteomalacia after parathyroidectomy developed after operation in two patients. Both had positive aluminium stains for excess aluminium in their bone. Numbers of osteoclasts and the amount of marrow fibrosis declined in parallel following parathyroidectomy, but woven bone persisted for months or years.

Adult↗
PubMed1990

[Effect of parathyroidectomy on enamel formation of incisors in rats].

A chronological study on the enamel formation of the incisors in male Wistar rats was undertaken following parathyroidectomy by using glyoxalbis (2-hydroxyanil) stain, ground sections, and scanning and transmission electron micrographs. In addition, the effect of activated vitamin D3 administration on the enamel formation in parathyroidectomized rats was investigated using the same procedures. The following results were obtained. 1) Effects of parathyroidectomy (1) Macroscopic observation and the changes in body weight. The tetany after parathyroidectomy was not observed in this study. However, the reduction of behavior, loss of glistening of body hair, and standing of body hair became evident with time. There was a tendency for loss of the increased body weight as compared with that in normal rats. In the incisors, there were no macroscopic abnormal findings in shape and color. (2) Chronological alterations in serum Ca and P concentration. Serum Ca concentration decreased abruptly until 1 week after parathyroidectomy and the condition of lower concentration of serum Ca remained unchanged after 2 weeks of parathyroidectomy. Serum P concentration increased until 2 weeks after parathyroidectomy, but thereafter it decreased slightly and additionally the condition of higher concentration of serum P remained unchanged. (3) Morphological alterations in ameloblast layer and enamel matrix. No evident changes were observed at the stage of division and proliferation of ameloblasts after parathyroidectomy. But in the morphology of ameloblasts and intercellular organelle at the stage of formation and maturation, various changes were observed: namely atropy, deformities and degeneration of ameloblasts, irregular swelling, disruption and liberation of rough endoplasmic reticulum, disappearance of attached ribosomes, indistinctness of Golgi apparatus, expansion of perinuclear space, reduction in number of mitochondria and loss of crista. In the ameloblasts at the stage of matrix formation and maturation, vacuoles of various sizes were observed, and increases in number and growth in size were seen chronologically. Furthermore, after 4 weeks of parathyroidectomy, cyst formation was observed and enamel hypoplasia was limited only to the superficial layer of enamel. Calcium value at the site of enamel tubules was one fiftieth as much as that of normal rats on the ameloblastic side after 5 weeks of parathyroidectomy and was reduced to one-half at intermediate site. Similarly, P value was reduced.(ABSTRACT TRUNCATED AT 400 WORDS)

Ameloblasts↗
PubMed1991

Total parathyroidectomy alone or with autograft for renal hyperparathyroidism?

Seventy-six patients underwent parathyroidectomy for renal hyperparathyroidism. There were 10 subtotal parathyroidectomies, 49 total parathyroidectomies with implantation of part of one gland as an autograft, nine total parathyroidectomies with no autograft, and eight patients in whom only three parathyroid glands were found. In 34 dialysis patients who underwent total parathyroidectomy with an autograft there was a high rate of recurrent hyperparathyroidism after 6 years in those remaining on dialysis. Fifty per cent had asymptomatic recurrent hyperparathyroidism and 30 per cent required partial autograft excision for symptomatic hyperparathyroidism. In contrast, recurrent hyperparathyroidism was rare in renal transplant recipients with good renal function. This favourable outcome did not depend upon whether parathyroid surgery was performed before or after transplantation, or on the type of parathyroidectomy. Total parathyroidectomy without an autograft was performed in nine dialysis patients without any short-term adverse effects, and with clinical and pathological improvement in bone disease. In summary, the results of surgery for renal hyperparathyroidism were excellent in patients who received a successful renal transplant. However, there was a high incidence of recurrent hyperparathyroidism in patients who remained on long-term dialysis. Total parathyroidectomy without an autograft may be the treatment of choice in patients unlikely to receive a renal transplant.

Adult↗
PubMed1990

Parathyroidectomy in chronic renal failure: indications, surgical approach and the use of calcitriol.

The appropriate use of phosphate binders, calcium supplements and especially calcitriol therapy has significantly decreased the incidence of overt secondary hyperparathyroidism in dialysis patients. Nevertheless some patients may still need parathyroidectomy, especially in the event of severe clinical signs and symptoms such as persistent hypercalcemia, pruritus, calcifilaxis, or extensive extra-skeletal calcification. Since aluminum-induced bone disease may resemble hyperparathyroidism in dialysis patients, whenever parathyroidectomy is contemplated the diagnosis of secondary hyperparathyroidism must be firmly established. Thus, a bone biopsy is mandatory prior to parathyroidectomy. It is our experience that once the patient goes to surgery the most important factor in the surgical approach is the presence of a skilled surgeon who has extensive experience in parathyroid gland surgery. The data comparing subtotal parathyroidectomy with total parathyroidectomy and autotransplantation are similar. The most important shortcoming is the lack of long-term follow-up. Recently, new data by several investigators has been advanced reintroducing total parathyroidectomy. Long-term observations in patients who despite total parathyroidectomy still have normal PTH levels are of special interest. In addition, long-term follow-up of these patients has shown that normal plasma calcium and phosphorus levels may be maintained without the use of Vitamin D; this occurred in the presence of active mineralization. However, our major objection to this procedure is the risk of aluminum-induced bone disease. At the present time we feel that the relative high incidence of recurrent hyperparathyroidism following subtotal parathyroidectomy is a reasonable trade off for the risk of aluminum bone disease which may develop in absence of PTH.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcitriol↗
PubMed1985

Effect of parathyroidectomy on bone aluminum accumulation in chronic renal failure.

In some patients with chronic renal failure, bone mineralization becomes defective after parathyroidectomy for secondary hyperparathyroidism. Because aluminum deposition in bone is associated with impaired bone formation and osteomalacia, we retrospectively studied bone-biopsy specimens from patients on hemodialysis who were not exposed to dialysate contaminated with aluminum, to determine whether aluminum accumulation on bone surfaces was enhanced by parathyroidectomy. Serial biopsy specimens taken before and after parathyroidectomy revealed an increase in the rate of aluminum deposition on the surface of mineralized bone after parathyroidectomy in each of the six patients studied. The accelerated rate of aluminum accumulation could not be explained by changes in the oral aluminum intake. The mean rate of bone formation (+/- S.E.M.) before parathyroidectomy was higher in the six patients than in six control patients who did not undergo parathyroid surgery (586 +/- 147 vs. 237 +/- 85 micron2 per square millimeter per day; P less than 0.05). After parathyroidectomy, the rate of bone formation fell to levels below normal (148 +/- 32 vs. 311 +/- 29 micron2 per square millimeter per day; P less than 0.05) but was not significantly different from the rate in the control group (319 +/- 126 micron2 per square millimeter per day). We conclude that parathyroidectomy in patients with chronic renal failure is associated with enhanced aluminum deposition on the bone surface, possibly as a result of low bone formation. Patients with secondary hyperparathyroidism who may be candidates for parathyroidectomy should be evaluated for aluminum excess before surgery, so that treatment with aluminum chelation may be considered.

Aluminum↗
PubMed1987

Effect of calcitriol in the control of plasma calcium after parathyroidectomy. A placebo-controlled, double-blind study in chronic hemodialysis patients.

Severe, prolonged hypocalcemia in observed in some, but not all, hemodialysis patients after parathyroidectomy performed because of uncontrolled hyperparathyroidism. The aim of the present study was to investigate whether calcitriol and calcium supplementation in the immediate period after parathyroidectomy (days 1-14) was of more help in the control of plasma calcium than calcium supplementation alone. Fourteen hemodialysis patients were enrolled in a prospective, randomized, double-blind and placebo-controlled study. From the day after parathyroidectomy, 7 patients received calcitriol and the remaining 7 a placebo using incremental doses adjusted to the degree of hypocalcemia (up to 4 micrograms/day for calcitriol). Plasma calcium, phosphorus, alkaline phosphatase and immunoreactive parathyroid hormone levels before parathyroidectomy were comparable in both patients groups, as was the lowest plasma calcium achieved after parathyroidectomy. The decrease in plasma calcium after parathyroidectomy was related to plasma alkaline phosphatase and to the number of osteoclasts and osteoblasts on bone biopsy surface before parathyroidectomy. The mean decrement of plasma calcium (days 3-9) as compared to that before parathyroidectomy was less pronounced in calcitriol-treated than in placebo-treated patients (0.25 +/- 0.06 versus 0.45 +/- 0.05 mM, mean +/- SEM, p less than 0.025). Treatment with placebo was interrupted before day 14 because of persistent severe hypocalcemia in 4 of 7 patients, whereas calcitriol treatment was continued in all 7 patients up to 14 days. Patients on calcitriol treatment required less mean calcium supplements (days 1-9) than patients receiving placebo (37.4 +/- 3.2 versus 49.4 +/- 3.7 g, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Calcitriol↗
PubMed1988

Long-term effects of parathyroidectomy on cardiac and autonomic nervous system functions in haemodialysis patients.

Ten patients receiving regular haemodialysis therapy who underwent parathyroidectomy for secondary hyperparathyroidism were investigated to evaluate the effects of parathyroid hormone on left ventricular and autonomic nervous system functions. The study which included M-mode echocardiography and autonomic nervous system tests (hormonal and cardiovascular response to the postural test, cold pressor test, handgrip test, diving reflex test and Valsalva manoeuvre) were performed prior to parathyroidectomy, and 5-8 months after, on a nondialysis day. The cardiovascular response and plasma noradrenaline changes to postural test remained unchanged following parathyroidectomy. The resting heart rate decreased from 73.1 +/- 2.4 to 66.4 +/- 2.3 beats/min (P less than 0.05) but mean blood pressure did not change post-parathyroidectomy. Mean blood pressure and heart rate changes during the cold pressor test, handgrip test, diving test and Valsalva manoeuvre were unaffected by parathyroidectomy. End-diastolic and end-systolic dimensions, fractional fibre shortening, mean velocity of fibre shortening and the ratio of the pre-ejection period to the left ventricular ejection time were normal prior to parathyroidectomy and remained unchanged following it. This study suggests that the reduction in parathyroid hormone concentrations obtained by parathyroidectomy does not significantly modify heart function and autonomic nervous system activity in the long term.

Adult↗
PubMed1987

Lack of effect of parathyroidectomy or calcium channel blockade on serum gastrin concentration and gastric acid secretion in a patient with hyperparathyroidism and Zollinger-Ellison syndrome.

Management of patients with multiple endocrine neoplasia type I (Wermer's syndrome) who have concurrent hypercalcemia and hypergastrinemia is controversial. The usual therapeutic approach has been to perform parathyroidectomy first before surgery for ulcer disease in an effort to decrease serum calcium concentration and presumably remove one of the stimuli for both gastrin and gastric acid secretion. We present the history of a 48-year-old man with primary hyperparathyroidism and Zollinger-Ellison syndrome who underwent acid secretory studies and secretin stimulation tests before and after parathyroidectomy. We also studied the effect of calcium channel blockade on gastrin and gastric acid secretion, since calcium influx into endocrine cells, such as the gastrinoma cell, is thought to be critical in hormone secretion. Although parathyroidectomy reduced serum calcium and parathormone levels to normal, basal serum gastrin concentration and basal acid output remained unchanged. The peak rise in serum gastrin concentration after secretin injection was less after parathyroidectomy than before parathyroidectomy but was still abnormal. During administration of verapamil, a calcium channel antagonist, no change was seen in the serum gastrin concentration, secretin test response, or acid secretion. Basal acid output was 45.4 mmol/hr before parathyroidectomy or verapamil and 54.0 and 50.4 mmol/hr after parathyroidectomy or verapamil, respectively. In contrast, a small but significant decrease (p less than 0.05) in serum parathormone concentration occurred during treatment with verapamil, an observation that to the best of our knowledge has not been previously reported in humans.

Calcium Channel Blockers↗
PubMedDate not supplied

Serum bone Gla protein as an indicator of parathyroidectomy in patients with secondary hyperparathyroidism.

Bone Gla protein (BGP) is a vitamin K-dependent protein which is a marker of bone turnover. To determine whether serum BGP is a useful indicator for parathyroidectomy in patients with secondary hyperparathyroidism, we measured serum BGP levels. Thirty-seven patients with secondary hyperparathyroidism who were followed up for more than 1 year after parathyroidectomy were studied. All patients underwent total parathyroidectomy and autotransplantation. Controls were 46 patients who were treated by chronic hemodialysis for more than 3 years. Serum BGP levels (normal: less than 6.5 ng/ml) were markedly increased in 37 patients with parathyroidectomy, ranging from 4.2 ng/ml to 645 ng/ml, with a mean value of 278.8 +/- 159.8 ng/ml (mean +/- standard deviation) versus 65.0 +/- 85.2 ng/ml in the 46 controls (p less than 0.001). Patients with a high BGP level had severe bone and joint pain. Serum BGP in patients with parathyroidectomy was significantly correlated with serum alkaline phosphatase and mPTH (p less than 0.001 for both). The total weight of resected parathyroid tumors was 2,152 +/- 1,368 mg, and tumor weights ranged from 200 mg to 5,600 mg. There was a highly significant correlation between BGP level and tumor weight (r = 0.656, p less than 0.001). The 2 patients who showed BGP levels below 10 ng/ml had tumor weights of only 470 mg and 240 mg, respectively, and revealed no improvement of pain postoperatively, although their mPTH levels were increased. These results suggested that BGP measurement is a sensitive method for detecting increased bone turnover and is possibly useful as an indicator for parathyroidectomy in patients with secondary hyperparathyroidism.

Adult↗