title: Infarction of mediastinal parathyroid gland causing spontaneous remission of secondary hyperparathyroidism.
abstract: Secondary hyperparathyroidism is a serious complication in long-term hemodialysis patients. The authors report on 2 patients on long-term hemodialysis who suffered from persistent secondary hyperparathyroidism due to missed mediastinal parathyroid gland after total parathyroidectomy with forearm autograft. Reoperation was planned. In both cases, severe hypocalcemia suddenly developed; serum parathyroid hormone (PTH) level decreased markedly after this episode. The serum calcium level increased gradually in response to administration of vitamin D and calcium carbonate, but serum PTH level remained low. A follow-up computed tomography scan showed that the formerly enlarged mediastinal parathyroid gland was markedly reduced in size. Moreover, a hot spot formerly detected by technetium 99m-MIBI (methoxy-isobutyl-isonitrile) scintigraphy in the mediastinum disappeared after this episode. The authors considered that necrosis of the enlarged ectopic parathyroid gland, probably due to infarction, resulted in hypocalcemia. To the authors' knowledge, this is the first case report of spontaneous mediastinal parathyroid autoinfarction after parathyroidectomy in hemodialysis patients.
authors.affiliation: Department of Nephrology, Akebono Clinic, Kumamoto, Japan. tanaka@matusita-kai.or.jp
authors.forename: Motoko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tominaga
authors.forename: Eizou
authors.initials: E
authors.lastname: Sawatari
authors.forename: Kazuko
authors.initials: K
authors.lastname: Itoh
authors.forename: Kazunori
authors.initials: K
authors.lastname: Matsushita
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Matsushita
authors.forename: Susumu
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Ueki
authors.forename: Norihiko
authors.initials: N
authors.lastname: Goto
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Sato
authors.forename: Akio
authors.initials: A
authors.lastname: Katayama
authors.forename: Toshihito
authors.initials: T
authors.lastname: Haba
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Uchida
mesh_terms: D002828:Choristoma / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000209:etiology / Q000503:physiopathology*; D006996:Hypocalcemia / Q000209:etiology; D007238:Infarction / Q000503:physiopathology*; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000503:physiopathology*; D008875:Middle Aged; D010280:Parathyroid Glands / Q000098:blood supply*; D016105:Parathyroidectomy; D012075:Remission, Spontaneous; D006435:Renal Dialysis / Q000009:adverse effects