TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMA

• Main Authors: Mara Carsote, Simona Elena Albu, Florica Sandru, Mihai Cristian Dumitrascu, Andrei Goldstein, Ana Valea
• Format: Article
• Language: English
• Published: Amaltea Medical Publishing House 2019-12-01
• Series: Romanian Medical Journal
• Subjects: parathormone; hyperparathyroidism; renal failure
• Online Access: https://revistemedicale.amaltea.ro/Romanian_MEDICAL_Journal/Revista_MEDICALA_ROMANA-2019-Nr.4/RMJ_2019_4_Art-23.pdf
• ISSN: 1220-5478; 2069-606X

Renal failure is associated with numerous complications including cardiovascular, dermatological, neurological, surgical and endocrine. Hypovitaminosis D induces secondary hyperparathyroidism and long term effects are represented by autonomous stimulation of the parathyroid glands (tertiary hyperparathyroidism). Fail of PTH (parathyroid hormone) levels control through vitamin D replacement makes necessary a surgical intervention because of the risk of chronic complications in addition to the general morbidities caused by chronic kidney disease including osteoporosis. Our aim is to present a case of an adult woman with a very long history of renal failure complicated with tertiary hyperparathyroidism and osteoporosis. The clue of the case is the difficult localisation of PTH source after total parathyroidectomy was previously done in order to remove it and timing of re-intervention. There is a challenge to adequately locate the parathyroid remnants after a prior glands removal and a skilled surgeon is still the best “tool”. However, the risk of surgery in a cases with multiple complications is very high so it is preferable a pre-operatory localisation. The neck ultrasound is the most accessible tool offering a good accuracy if there is no mediastinal localisation and also the combination with parathyroid scintigram increases the rate of detection.