Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report
Parathyroid carcinoma (PC) in cases of secondary or tertiary hyperparathyroidism is relatively uncommon, and only a few case reports have described this entity. Although some papers have reported patients with one or two parathyroid malignancies, multiple PC–especially three or more–have been even m...
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| Format: | Article |
| Language: | English |
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Kosin University College of Medicine
2022-09-01
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| Series: | Kosin Medical Journal |
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| Online Access: | http://www.kosinmedj.org/upload/pdf/kmj-22-103.pdf |
| _version_ | 1797991304100052992 |
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| author | Soree Ryang Wook Yi Mijin Kim Sang Heon Song Byung Joo Lee Bo Hyun Kim |
| author_facet | Soree Ryang Wook Yi Mijin Kim Sang Heon Song Byung Joo Lee Bo Hyun Kim |
| author_sort | Soree Ryang |
| collection | DOAJ |
| description | Parathyroid carcinoma (PC) in cases of secondary or tertiary hyperparathyroidism is relatively uncommon, and only a few case reports have described this entity. Although some papers have reported patients with one or two parathyroid malignancies, multiple PC–especially three or more–have been even more rarely reported. Herein, we report a case of secondary hyperparathyroidism due to multiple PCs in a chronic hemodialysis patient. A 54-year-old man with end-stage kidney disease was referred for hyperparathyroidism. He had been diagnosed with chronic kidney disease in 2001 and had begun hemodialysis in 2009. In laboratory tests, intact parathyroid hormone (iPTH) was markedly elevated to 1,144.1 pg/mL (normal range: 15.0–68.3 pg/mL) and serum calcium was mildly elevated to 10.56 mg/dL (normal range: 8.5–10.3 mg/dL). Ultrasonography showed hypoechoic nodules in the posterior part of both thyroid glands. All three nodules showed increased uptake on a 99mTc sestamibi scan. The patient underwent total parathyroidectomy with autotransplantation to the right forearm. Histopathology findings showed three PCs with capsular invasion and one parathyroid hyperplasia. In the immediate postoperative period, the iPTH level dropped from 1,446.8 to 82.4 pg/dL and, after 1 month, to 4.0 pg/dL. This patient needed oral calcium carbonate and active vitamin D to maintain appropriate serum calcium levels. Although multiple PCs are rare, they can cause secondary hyperparathyroidism. Therefore, clinicians should suspect multiple PCs when patients’ serum iPTH levels are exceptionally high. Additionally, since PCs could occur in multiple glands, autotransplantation of the parathyroid gland after parathyroidectomy should be done carefully. |
| first_indexed | 2024-04-11T08:49:51Z |
| format | Article |
| id | doaj.art-b22f532f388540668629630db9b70d49 |
| institution | Directory Open Access Journal |
| issn | 2005-9531 2586-7024 |
| language | English |
| last_indexed | 2024-04-11T08:49:51Z |
| publishDate | 2022-09-01 |
| publisher | Kosin University College of Medicine |
| record_format | Article |
| series | Kosin Medical Journal |
| spelling | doaj.art-b22f532f388540668629630db9b70d492022-12-22T04:33:38ZengKosin University College of MedicineKosin Medical Journal2005-95312586-70242022-09-0137325525910.7180/kmj.22.1031198Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case reportSoree Ryang0Wook Yi1Mijin Kim2Sang Heon Song3Byung Joo Lee4Bo Hyun Kim5 Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University Hospital, Busan, Korea Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, KoreaParathyroid carcinoma (PC) in cases of secondary or tertiary hyperparathyroidism is relatively uncommon, and only a few case reports have described this entity. Although some papers have reported patients with one or two parathyroid malignancies, multiple PC–especially three or more–have been even more rarely reported. Herein, we report a case of secondary hyperparathyroidism due to multiple PCs in a chronic hemodialysis patient. A 54-year-old man with end-stage kidney disease was referred for hyperparathyroidism. He had been diagnosed with chronic kidney disease in 2001 and had begun hemodialysis in 2009. In laboratory tests, intact parathyroid hormone (iPTH) was markedly elevated to 1,144.1 pg/mL (normal range: 15.0–68.3 pg/mL) and serum calcium was mildly elevated to 10.56 mg/dL (normal range: 8.5–10.3 mg/dL). Ultrasonography showed hypoechoic nodules in the posterior part of both thyroid glands. All three nodules showed increased uptake on a 99mTc sestamibi scan. The patient underwent total parathyroidectomy with autotransplantation to the right forearm. Histopathology findings showed three PCs with capsular invasion and one parathyroid hyperplasia. In the immediate postoperative period, the iPTH level dropped from 1,446.8 to 82.4 pg/dL and, after 1 month, to 4.0 pg/dL. This patient needed oral calcium carbonate and active vitamin D to maintain appropriate serum calcium levels. Although multiple PCs are rare, they can cause secondary hyperparathyroidism. Therefore, clinicians should suspect multiple PCs when patients’ serum iPTH levels are exceptionally high. Additionally, since PCs could occur in multiple glands, autotransplantation of the parathyroid gland after parathyroidectomy should be done carefully.http://www.kosinmedj.org/upload/pdf/kmj-22-103.pdfcase reportsparathyroid neoplasmsrenal insufficiency, chronicsecondary hyperparathyroidism |
| spellingShingle | Soree Ryang Wook Yi Mijin Kim Sang Heon Song Byung Joo Lee Bo Hyun Kim Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report Kosin Medical Journal case reports parathyroid neoplasms renal insufficiency, chronic secondary hyperparathyroidism |
| title | Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report |
| title_full | Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report |
| title_fullStr | Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report |
| title_full_unstemmed | Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report |
| title_short | Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report |
| title_sort | secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis a case report |
| topic | case reports parathyroid neoplasms renal insufficiency, chronic secondary hyperparathyroidism |
| url | http://www.kosinmedj.org/upload/pdf/kmj-22-103.pdf |
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