Differential diagnosis between secondary hyperparathyroidism and aluminum intoxication in uremic patients: usefulness of 99mTc-pyrophosphate bone scintigraphy.
Forty-one patients in chronic end-stage renal failure and 4 patients with a functioning kidney transplant presented with spontaneous hypercalcemia or intolerance to vitamin D3 sterols and/or oral calcium supplements. Bone iliac crest biopsy with aluminum staining and Tc-pyrophosphate bone scintigraphy with determination of Fogelman score were performed in all cases. Two patients had aluminum-induced osteomalacia (AL O). Thirty-eight biopsies showed renal osteodystrophy (secondary hyperparathyroidism or various combinations of osteitis fibrosa and osteomalacia): 19 with positive staining for aluminum (RO + AL) and 19 without aluminum deposits (RO). The series also comprised 2 cases of pure osteomalacia (OM), 2 cases of osteoporosis (OP), and 1 case of osteoporosis with aluminum accumulation (OP + AL). Mean Fogelman score in RO patients (9.1 +/- 0.3) was significantly higher than in all other categories (5.9 +/- 0.5 for RO + AL, and scores ranging from 0 to 8 in the last 7 patients, p less than 0.01). Patients with massive aluminum accumulation in bone (greater than 75% of the total trabecular surface) showed no or very low uptake of the isotope by the skeleton. Fogelman scores of 9 or higher were always associated with histological secondary hyperparathyroidism. 99mTc-pyrophosphate bone scintigraphy is helpful to distinguish aluminum intoxication from secondary hyperparathyroidism in uremic patients.
Kinnaert
P
P
Van Hooff
I
I
Schoutens
A
A
Bergmann
P
P
Fuss
M
M
Dratwa
M
M
Vienne
A
A
Pasteels
J L
JL
van Geertruyden
J
J
Vanherweghem
J L
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000535:Aluminum / Q000506:poisoning*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D011756:Diphosphates; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging*; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010018:Osteomalacia / Q000139:chemically induced / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D013667:Technetium; D016698:Technetium Tc 99m Pyrophosphate
D011756:Diphosphates; D016698:Technetium Tc 99m Pyrophosphate; D013667:Technetium; D000535:Aluminum