Severe Hyperparathyroidism with Hypercalcemia Associated with Chronic Renal Failure at Pre-Dialysis Stage

Endocrine Journal

YUKIO NAKATANI¹  HIROSHI SHIONOIRI²  MACHIKO YABANA²  NOBUYOSHI TAKAGI²  SATOSHI UMEMURA²  IZUMI TAKASAKI²  SEIKO KAMIJO¹ 

[1] Division of Anatomic and Surgical Pathology, Hospital of Yokohama City University;Second Department of Internal Medicine, Yokohama City University School of Medicine

关键词: Secondary hyperparathyroidism;    Tertiary hyperparathyroidism;    Chronic renal failure;    Hypercalcemia;    Hyperphosphatemia;   

DOI  :  10.1507/endocrj.46.167

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(12)Cited-By(2)We report a case of a 23-year-old Japanese woman who had severe hyperparathyroidism associated with chronic renal failure before the start of dialysis treatment. Her chief complaints were swelling and pain in both shoulders. Laboratory examination revealed renal failure (BUN 134mg/dl, serum Cr 7.3mg/dl), severe normocytic normochromic anemia (hemoglobin 4.3g/dl), hypercalcemia (11.8mg/dl), and hyperphosphatemia (9.7mg/dl). Serum PTH levels were extremely increased (intact PTH>1, 000pg/ml: normal range 10-50pg/ml). X-ray examination of the skull and shoulders showed a salt and pepper appearance, and cauliflower-like deformity of the distal end of both clavicles, respectively. Accelerated ectopic calcification was observed in the costal cartilages, internal carotid arteries, and splenic arteries. Ultrasonographic examination revealed enlargement of the four parathyroid glands. Thallium-technetium subtraction scintigraphy of the parathyroid glands showed increased uptake into the upper two. Renal needle biopsy revealed severe impairment of the interstitium and tubules with much milder changes in glomeruli. The etiology of the renal failure could not be identified. Hemodialysis, total parathyroidectomy and auto-transplantation into the forearm were immediately performed. The pathological diagnosis was chief cell hyperplasia of the parathyroid glands. Based on the presence of chronic renal failure, remarkable hyperphosphatemia with mild hypercalcemia, an unusually high level of serum PTH, and accelerated ectopic calcification, the patient was diagnosed to have severe secondary hyperparathyroidism caused by chronic renal failure with major impairment of the renal interstitium and tubules.

【 授权许可】

Unknown