title: Rapid recurrence of hyperparathyroidism from both nodularly hyperplastic autograft at forearm and residual tissues at neck after parathyroidectomy in a hemodialysis patient with calciphylaxis.
abstract: A 42-year-old woman underwent hemodialysis secondary to diabetic nephropathy. Total parathyroidectomy with forearm autograft was performed due to secondary hyperparathyroidism (HPT) complicated with calciphylaxis. Rapidly progressive enlargement of autograft with unusual "gourd-shape" developed, and then it was removed. Pathologic examination of the autograft disclosed multinodular hyperplasia. Residual parathyroid gland in the retrothyroid region was found later. Rapidly recurrent HPT originating from both the residual parathyroid tissues and the enlarged autograft within such short time after parathyroidectomy is rare in the literature. The multinodular hyperplasia pattern of the parathyroid gland may be a major factor for such rapid recurrence. In addition to good control of calcium and phosphate, regular follow-up of parathyroid hormone level and imaging studies of not only autografted gland at the forearm but also possibly residual parathyroid tissues at the neck are important for monitoring recurrence in maintenance hemodialysis patients after parathyroidectomy with forearm autograft, especially in those with pathologic type of nodular hyperplasia and calciphylaxis.
authors.affiliation: Division of Nephrology, department of Medicine, Taipei, Taiwan.
authors.forename: Chun-Tung
authors.initials: CT
authors.lastname: Yeh
authors.forename: Yao-Ping
authors.initials: YP
authors.lastname: Lin
authors.forename: Wu-Chang
authors.initials: WC
authors.lastname: Yang
authors.forename: An-Han
authors.initials: AH
authors.lastname: Yang
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Lai
authors.forename: Chih-Ching
authors.initials: CC
authors.lastname: Lin
mesh_terms: D000328:Adult; D002115:Calciphylaxis / Q000150:complications*; D002118:Calcium / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005542:Forearm / Q000473:pathology; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006965:Hyperplasia / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D009333:Neck / Q000473:pathology; D010280:Parathyroid Glands / Q000473:pathology* / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D010710:Phosphates / Q000097:blood; D012008:Recurrence; D006435:Renal Dialysis; D014182:Transplantation, Autologous
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium