Abstract
We recently experienced two pediatric patients on maintenance hemodialysis in whom we were unable to make a decisive conclusion as to the indication for parathyroidectomy (PTx). The indications for PTx in pediatric patients have not been clearly described. In this study we evaluated the functional status of the parathyroid glands, clinical symptoms and signs, and the accumulation of aluminium in 17 patients on chronic hemodialysis. The function of the parathyroid glands was well controlled in 14/17 patients (82.4%), suggesting that secondary hyperparathyroidism (2°HPT) could be satisfactorily controlled by medical treatment alone. However, we had two cases with severe 2°HPT, both of whom had shown long-term ‘non-compliance’ on medications. Our data indicated that meticulous care of “compliance” with medication must be taken in managing patients, especially children, to prevent the progression of 2°HPT. 2°HPT in pediatric patients was chracterized by a paucity of clinical manifestations in spite of severe bone deformities and growth retardation. Thus, delayed performance of PTx as well as dwelling on medical treatment might lead to irreversible bone destruction accompanied by growth retardation. In recent years, the adverse effects of PTx on Al related osteomalacia have been reported. We noted the co-existence of both 2°HPT and Al accumulation in our patients. After a loading of desferrioxamine (20mg/kg), a significant increment of serum Al (200μg/l) was noted in 9 of the 17 (52.9%) patients. The amount of Al accumulation was closely related to the duration of hemodialysis. In our parathyroidectomized patient, the after loading increment of Al was 240μg/l, demonstrating massive accumulation of Al. From these results, PTx should be performed in patients after evaluating Al accumulation. In the future, the toxicity of accumulated Al will be closed up in pediatric patients. So, the following problems remain to be solved: 1) to load as little Al as possible and 2) to establish safe and effective methods of removing accumulated Al.
