title: Recurrent renal hyperparathyroidism caused by parathyromatosis.
abstract: BACKGROUND
  Parathyromatosis is defined as multiple foci of benign hyperfunctioning parathyroid tissue in the neck or mediastinum. Parathyromatosis is a problematic cause of recurrent hyperparathyroidism (HPT). In renal HPT, the stimuli of the parathyroid cells persist after parathyroidectomy (PTx), and for this reason, parathyromatosis might be important in renal HPT.
  
  
  METHODS
  Between July 1973 and December 2005, 1,932 patients underwent PTx for advanced renal HPT in our department. We evaluated the frequency, clinical findings and the prognosis of this kind of parathyroid disorder.
  
  
  RESULTS
  After total PTx with forearm autograft for renal HPT, which was performed initially in our department, the risk for developing parathyromatosis was 0.11% (2/1837); after sub-total PTx, it was 5% (1/20). The risk for developing parathyromatosis was lower after total PTx with forearm autograft than after sub-total PTx (P < 0.05). In patients who developed persistent or recurrent HPT and were referred to our department for neck re-operation, parathyromatosis occurred in 12.1% (7/58); in those originally operated on at our hospital, the corresponding figure was 7.1% (3/42). This difference was not significant (P = 0.42). Only in 4 of 10 patients was parathyromatosis suggested before re-operation. However, in spite of several re-operations, high parathyroid hormone (PTH) levels persisted in 6 of 10 patients with parathyromatosis.
  
  
  CONCLUSIONS
  Parathyromatosis is a non-negligible cause of recurrent renal HPT in patients who require neck re-exploration. Parathyromatosis is difficult to diagnose pre-operatively and completely controlled by re-operation. Parathyromatosis should be kept in mind when performing neck re-exploration for recurrent renal HPT.
authors.affiliation: Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. matsuoka@nagoya2.jrc.or.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tominaga
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Sato
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Uno
authors.forename: Norihiko
authors.initials: N
authors.lastname: Goto
authors.forename: Akio
authors.initials: A
authors.lastname: Katayama
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Uchida
authors.forename: Toyonori
authors.initials: T
authors.lastname: Tsuzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002828:Choristoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D008477:Mediastinal Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D009333:Neck; D010280:Parathyroid Glands; D016105:Parathyroidectomy; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome