The reversed ratio of 1-84 PTH (whole PTH)/intact PTH in a patient on hemodialysis associated with primary hyperparathyroidism.
Intact PTH measures not only 1-84 PTH, but also other fragments such as 7-84 PTH. Lately, a measurement of 1-84 PTH has been available as whole PTH assay and the ratio of whole PTH/intact PTH is considered to be between 0.5 and 0.7 in patients on hemodialysis. Therefore, intact PTH should be higher than whole PTH. We present a 57-year-old male with chronic renal failure on hemodialysis whose whole PTH was higher than intact PTH (the reversed ratio of whole PTH/intact PTH). He showed one enlarged parathyroid gland by an ultrasonic test, CT examination and RI subtraction study. After this gland was removed by surgery, the ratio of whole PTH/intact PTH normalized. The size of the resected gland was 22 x 15 x 11 mm. The histologic examination revealed adenoma. This indicates that, if patients with chronic renal failure showed the reversed ratio of whole PTH/intact PTH, the possibility that they could have primary hyperparathyroidism in addition to secondary hyperparathyroidism should be considered.
Mizumura
Y
Y
Division of Nephrology and Dialysis, Eight Nine Medical Clinic, Ageo, Japan. mizumura@ach.or.jp
Mukaiyama
Y
Y
Osada
H
H
Hida
O
O
Nishimiya
M
M
Nakamura
Y
Y
D000236:Adenoma / Q000175:diagnosis; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000209:etiology / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000175:diagnosis; D016105:Parathyroidectomy; D006435:Renal Dialysis
D010281:Parathyroid Hormone