title: Diagnostic dilemma of an unsuspected hyperfunctioning accessory parathyroid gland after total parathyroidectomy with autotransplantation in a peritoneal dialysis patient.
abstract: Persistent or recurrent hyperparathyroidism in patients with chronic renal failure may be a frustrating problem. We report a case history of a peritoneal dialysis patient who underwent total parathyroidectomy with autotransplantation for secondary hyperparathyroidism, developed tertiary hyperparathyroidism, and in an attempt to control hypercalcemia underwent seven partial resections of the autotransplant. Subsequently, a total excision of the parathyroid autograft was performed, but the patient continued to have hyperparathyroidism and unexpectedly was found to have a hyperplastic fifth parathyroid gland identified by thallium-technetium subtraction scan. The fifth gland was removed, and a part was implanted in the right forearm; however, the autoimplant had to be completely removed because of rapidly developing hypercalcemia. Hypercalcemia was controlled, but elevated levels of parathormone persisted. Remaining parathyroid tissue could not be found.
authors.affiliation: Department of Medicine, University of Missouri, Harry S. Truman Veterans Administration Hospital, Columbia.
authors.forename: H
authors.initials: H
authors.lastname: Krutak-Krol
authors.forename: C
authors.initials: C
authors.lastname: Mace
authors.forename: W K
authors.initials: WK
authors.lastname: Nichols
authors.forename: A
authors.initials: A
authors.lastname: Singh
authors.forename: Z J
authors.initials: ZJ
authors.lastname: Twardowski
mesh_terms: D005260:Female; D005542:Forearm; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008875:Middle Aged; D010280:Parathyroid Glands / Q000002:abnormalities* / Q000637:transplantation; D010530:Peritoneal Dialysis; D011877:Radionuclide Imaging; D012086:Reoperation; D013670:Sodium Pertechnetate Tc 99m; D013794:Thallium Radioisotopes; D014182:Transplantation, Autologous; D016042:Transplantation, Heterotopic
chemical_list: D013794:Thallium Radioisotopes; D013670:Sodium Pertechnetate Tc 99m