» Articles » PMID: 25984178

Recurrent Renal Hyperparathyroidism Due to Parathyromatosis

Overview
Journal NDT Plus
Specialty Nephrology
Date 2015 May 19
PMID 25984178
Citations 3
Authors
Affiliations
Soon will be listed here.
Abstract

Parathyromatosis is the most severe type of recurrent secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX) in haemodialysis patients. It is difficult to completely remove all foci of parathyroid tissue and neck re-explorations are often required. Here, we report for the first time a case of recurrent SHPT due to parathyromatosis treated by radio-guided PTX. A haemodialysed 48-year-old woman with recurrent SHPT due to parathyromatosis was treated by radio-guided PTX. Preoperatively Ultrasonography, (99)Tc-SestaMIBI scintigraphy and magnetic resonances of the neck and thorax were performed. The preoperative imaging techniques detected four parathyroid nodules, while intraoperative gamma probe identified six nodules (three in atypical site). No frozen sections were performed during surgery. Post-operative intact parathyroid hormone levels were stabilized in the range 300-500 pg/mL during the 26 month follow-up by means of cinacalcet and paricalcitol therapy. In cases of parathyromatosis, the preoperative imaging techniques are inadequate, while intraoperative gamma probe is useful to detect the parathyroid tissue and allows a more extensive cytoreduction because it ensures the removal of undetectable and ectopic parathyroid foci. The operative time is reduced and frozen sections are unnecessary. However, the radio-guided PTX do not rule out parathyromatosis recurrence and complementary medical treatment is appropriate.

Citing Articles

Recurrent parathyromatosis in a patient with concomitant MEN1 and CASR gene alterations: Clinical management of a case report and literature review.

Sapuppo G, Giusti M, Arico D, Masucci R, Tavarelli M, Russo M Front Endocrinol (Lausanne). 2023; 14:1108278.

PMID: 36998475 PMC: 10044612. DOI: 10.3389/fendo.2023.1108278.


Effective long-term management of parathyromatosis-related refractory hypercalcemia with a combination of denosumab and cinacalcet treatment.

Tzotzas T, Goropoulos A, Karras S, Terzaki A, Siolos A, Doumas A Hormones (Athens). 2022; 21(1):171-176.

PMID: 34993886 DOI: 10.1007/s42000-021-00343-w.


Recurrent primary hyperparathyroidism due to Type 1 parathyromatosis.

Jain M, Krasne D, Singer F, Giuliano A Endocrine. 2016; 55(2):643-650.

PMID: 27743301 DOI: 10.1007/s12020-016-1139-7.

References
1.
Tominaga Y, Katayama A, Sato T, Matsuoka S, Goto N, Haba T . Re-operation is frequently required when parathyroid glands remain after initial parathyroidectomy for advanced secondary hyperparathyroidism in uraemic patients. Nephrol Dial Transplant. 2003; 18 Suppl 3:iii65-70. DOI: 10.1093/ndt/gfg1017. View

2.
. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42(4 Suppl 3):S1-201. View

3.
Falvo L, Catania A, Sorrenti S, DAndrea V, Santulli M, De Antoni E . Relapsing secondary hyperparathyroidism due to multiple nodular formations after total parathyroidectomy with autograft. Am Surg. 2003; 69(11):998-1002. View

4.
Fernandez-Ranvier G, Khanafshar E, Jensen K, Zarnegar R, Lee J, Kebebew E . Parathyroid carcinoma, atypical parathyroid adenoma, or parathyromatosis?. Cancer. 2007; 110(2):255-64. DOI: 10.1002/cncr.22790. View

5.
Young E, Albert J, Satayathum S, Goodkin D, Pisoni R, Akiba T . Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2005; 67(3):1179-87. DOI: 10.1111/j.1523-1755.2005.00185.x. View