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Calciphylaxis: Is There a Role for Parathyroidectomy?

Authors

  • Mark D. Kriskovich MD,

    1. Division of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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  • John M. Holman MD,

    1. Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
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  • Jeffrey R. Haller MD

    Corresponding author
    1. Division of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah
    • Jeffrey R. Haller, MD, Division of Otolaryngology—Head and Neck Surgery, University of Utah School of Medicine, 50 North Medical Drive Salt Lake City, UT 84132, U.S.A.
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  • Presented at the Meeting of the Western Section of the American Laryngological, Rhinological and Otological Society, Inc., San Francisco, California, January 9, 2000.

Abstract

Objective Calciphylaxis, a rare disorder typically affecting renal failure patients, results in vascular calcification with subsequent skin necrosis, gangrene, and often death from sepsis. Parathyroid hormone is thought to act as a tissue sensitizer leading to these soft tissue changes. As such, parathyroidectomy is often advocated to control this complicated condition. A discussion of calciphylaxis does not exist in the otolaryngology literature, and head and neck surgeons performing parathyroidectomy should be aware of this phenomenon. This study evaluates the success of parathyroidectomy in reversing the ill effects of calciphylaxis in both our patient population and the literature.

Study Design Retrospective study and review of the literature.

Methods Five patients with calciphylaxis treated at our institution were evaluated for mortality, surgical and perioperative complications, wound healing, and predictors of patient outcomes.

Results Two patients died from sepsis and infectious complications of their calciphylaxis shortly after surgery. Of the three survivors, two later died (15 and 18 mo after surgery) from causes not directly related to calciphylaxis. The other long-term survivor required partial amputation of a leg for osteomyelitis. There was one operative complication— a wound infection requiring antibiotic therapy, drainage, and packing. Postoperative hypocalcemia required treatment in two patients. Immediate perioperative survival was more likely in patients with leukocyte counts less than 20,000 cells/mL.

Conclusions Calciphylaxis is a serious disease and patients often succumb to sepsis and infectious complications. Patients with extremely high leukocyte counts from coexistent infections may have a worse prognosis. Although a conclusive effective therapy does not exist, parathyroidectomy can be safely performed and may benefit some patients with what is often an otherwise fatal disease. The literature to date generally confirms our findings.

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