The role of the anesthesiologist in secondary hyperparathyroidism

In the last years the increasing of diabetes and hypertension has produced a considerable increase of patients with chronic renal failure; secondary hyperparathyroidism is one of the major complications. The resection of hyperfunctioning parathyroid tissue is the ultimate goal of the treatment. The preoperative examination by the anesthetist is the starting-point of the treatment. The anesthetist programs hemodialysis, the correction of fluid and electrolyte abnormalities and of the anaemia. In the operating room the anesthetist is involved in the careful monitoring of liquid infusion and anesthesiological procedure. The intraoperative parathyroid hormone (PTH) assay is an essential tool because the stress of orotracheal intubation elicits the raising of the catecholamine levels, and the catecholamines stimulates PTH secretion. Propofol can interfere with the intraoperative PTH assay causing an artificial reduction of PTH levels. This study highlights the difficulty in the application of anesthesiological protocol in the uremic patient.