Parathyroidectomy for Refractory Secondary Hyperparathyroidism with Severe Bone Disease
Abstract
Advances in the medical management of secondary hyperparathyroidism due to renal failure have decreased the use of parathyroidectomy as a treatment option. However, some patients with end-stage renal disease still progress to refractory hyperparathyroidism and debilitating bone disease, for which parathyroidectomy may be warranted. We describe a case of a 35-year-old female on chronic hemodialysis who presented with bone pains, deformities, decrease in height and recurrent pathologic fractures. She had markedly elevated parathyroid hormone (PTH), vitamin D deficiency, persistent hyperphosphatemia and hypocalcemia despite therapeutic measures. Subtotal parathyroidectomy was done with eventual improvement of biochemical abnormalities, resolution of bone pains and healing of fractures.Downloads
References
6th National Nutrition and Health Survey (NNHeS): 2003-2004. Food and Nutrition Research Institute, Department of Science and Technology Research and Development Institute. www.fnri.dost.gov.ph (Accessed April 17, 2012).
Conchol M. Secondary hyperparathyroidism in chronic kidney disease. US Nephrology 2006;(2):11-3.
Hruska KA, Teitelbaum SL. Renal osteodystrophy. N Engl J Med 1995; 333(3):166-74.
National Kidney Foundation. K/DOQI clinical practice guideline for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42(4 Suppl 3):S1-S201.
Cunningham J, Locatelli F, Rodriquez M. Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clin J Am Soc Nephrol 2011;6(4):913-21.
Owda A, Elhwairis H, Narra S et al., Towery H, Osama S. Secondary hyperparathyroidism in chronic hemodialysis patients: prevalence and race. Ren Fail 2003;25(4):595-602.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guidelines for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl 2009;76(113):S1-S130.
Gogusev J, Duchambon P, Hory B et al. Depressed expression of calcium receptor in parathyroid gland tissue of patients with hyperparathyroidism. Kidney Int 1997;51(1):328-36.
Jameson L, De Groot LJ. Endocrinology: Adult and pediatric. 6th ed. Philadelphia: Saunders Elsevier, 2010;9906-9907.
Tominaga Y, Tanaka Y, Sato K et al. Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 1997;13(2):78-86.
Katoh N, Nakayama M, Shigematsu T et al. Presence of sonographically detectable parathyroid glands can predict resistance to oral pulsed-dose calcitriol treatment of secondary hyperparathyroidism. Am J Kidney Dis 2000; 35(3):465-8.
Gagné ER, Ureña P, Leite-Silva S et al. Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients. J Am Soc Nephrol 1992;3(4):1008-17.
Abdelhadi M, Nordenström J. Bone mineral recovery after parathyroidectomy in patients with primary and renal hyperparathyroidism. J Clin Endocrinol Metab 1998;83(11):3845-51.
Rudser KD, de Boer IH, Dooley A et al. Fracture risk after parathyroidectomy among chronic hemodialysis patients. J Am Soc Nephrol 2007;18(8):2401-7.
Yasunaga C, Nakamoto M, Matsuo K et al. Effects of a parathyroidectomy on the immune system and nutritional condition in chronic dialysis patients with secondary hyperparathyroidism. Am J Surg 1999;178(4):332-6.
Tzanno-Martins C, Futata E, Jorgetti V et al. Restoration of impaired T-cell proliferation after parathyroidectomy in hemodialysis patients. Nephron 2000; 84(3):224-7.
Published
How to Cite
Issue
Section
License
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to jafes@asia.com or jafes.editor@gmail.com.
A written agreement shall be emailed to the requester should permission be granted.
