title: Relapsing secondary hyperparathyroidism due to multiple nodular formations after total parathyroidectomy with autograft.
abstract: Total parathyroidectomy with autograft represents an optimal surgical technique in the treatment of secondary hyperparathyroidism. Relapsing hyperparathyroidism due to miliary-type nodular formations scattered over the autograft site represents a complication that is rarely described in the literature. We examined five case histories of patients relapsing as a result of miliary-type nodular formations in the autograft site; in four cases the relapse was localized in the upper limb and in one case in a pouch of the sternocleidomastoid muscle. The patients underwent removal of the hyperfunctioning parathyroid formations accompanied by demolition of the surrounding muscle tissue. The relapsing hyperparathyroidism caused by multiple miliary-type nodular formations is a rare occurrence, akin to parathyromatosis. The increasingly widespread use of total parathyroidectomy with autograft to treat secondary hyperparathyroidism can lead to an increase in the incidence of this complication. Correct surgical technique and a careful selection of the parathyroid tissue to be autografted can prevent this complication. Furthermore, extensive demolition of the muscle tissue in the autograft site can prevent further relapses. Intraoperative rapid parathormone assay was found to be predictive of the disease's persistence and recurrence.
authors: Division of General Surgery, Department of Surgical Sciences, La Sapienza University of Rome, Rome, Italy.
authors: Laura
authors: L
authors: Falvo
authors: Antonio
authors: A
authors: Catania
authors: Salvatore
authors: S
authors: Sorrenti
authors: Vito
authors: V
authors: D'Andrea
authors: Maria
authors: M
authors: Santulli
authors: Enrico
authors: E
authors: De Antoni
mesh_terms: D000368:Aged; D001132:Arm; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles; D010280:Parathyroid Glands / Q000637:transplantation*; D016105:Parathyroidectomy; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects; D014182:Transplantation, Autologous / Q000009:adverse effects; D016042:Transplantation, Heterotopic / Q000009:adverse effects*