TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMA
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 hyperpar...
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doaj-c9bf012323bb4ed68aa607b7f651e1bd2021-09-02T17:33:42ZengAmaltea Medical Publishing HouseRomanian Medical Journal1220-54782069-606X2019-12-0166442142410.37897/RMJ.2019.4.23TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMAMara Carsote0Simona Elena Albu1Florica Sandru2Mihai Cristian Dumitrascu3Andrei Goldstein4Ana Valea5“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; Emergency University Hospital, Bucharest, Romania“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; Elias Emergency University Hospital, Bucharest, Romania“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; Emergency University Hospital, Bucharest, Romania“C.I. Parhon” National Institute of Endocrinology, Bucharest, RomaniaClinical County Hospital, Cluj-Napoca, Romania; “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, RomaniaRenal 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.https://revistemedicale.amaltea.ro/Romanian_MEDICAL_Journal/Revista_MEDICALA_ROMANA-2019-Nr.4/RMJ_2019_4_Art-23.pdfparathormonehyperparathyroidismrenal failure |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mara Carsote Simona Elena Albu Florica Sandru Mihai Cristian Dumitrascu Andrei Goldstein Ana Valea |
spellingShingle |
Mara Carsote Simona Elena Albu Florica Sandru Mihai Cristian Dumitrascu Andrei Goldstein Ana Valea TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMA Romanian Medical Journal parathormone hyperparathyroidism renal failure |
author_facet |
Mara Carsote Simona Elena Albu Florica Sandru Mihai Cristian Dumitrascu Andrei Goldstein Ana Valea |
author_sort |
Mara Carsote |
title |
TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMA |
title_short |
TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMA |
title_full |
TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMA |
title_fullStr |
TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMA |
title_full_unstemmed |
TERTIARY HYPERPARATHYROIDISM – LOCATION DILEMMA |
title_sort |
tertiary hyperparathyroidism – location dilemma |
publisher |
Amaltea Medical Publishing House |
series |
Romanian Medical Journal |
issn |
1220-5478 2069-606X |
publishDate |
2019-12-01 |
description |
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. |
topic |
parathormone hyperparathyroidism renal failure |
url |
https://revistemedicale.amaltea.ro/Romanian_MEDICAL_Journal/Revista_MEDICALA_ROMANA-2019-Nr.4/RMJ_2019_4_Art-23.pdf |
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