title: A case of primary hyperparathyroidism with severe bone and renal changes.
abstract: We report a 79-year-old Japanese woman who had primary hyperparathyroidism (HPT) with end-stage renal disease and severe bone changes. In 2004, she began to experience pain in her shoulders and knees, as well as muscle weakness and anorexia. She already had renal failure with a serum Cr of 4.7 mg/dl, while serum calcium was 9.6 mg/dl, PTH was 2,710 pg/ml, and serum alkaline phosphatase was 923 mU/ml. Multiple fractures of the pelvic bones and lumbar spine, osteoporosis, and subperiosteal bone resorption were detected. Although hemodialysis (HD) was started in February 2005, her symptoms became more severe. Total parathyroidectomy (PTX) and right iliac crest bone biopsy were performed. Histomorphometric analysis of the cancellous bone indicated a diagnosis of osteitis fibrosa, but a reduction of cortical bone and near absence of cancellous bone were also apparent. This showed that bone resorption by osteoclasts was predominant over bone formation by osteoblasts. Soon after PTX, her pain subsided completely. We conclude that primary HPT should be detected and treated early enough to avoid renal damage, since renal dysfunction markedly accelerates bone changes in patients with primary HPT.
authors.affiliation: Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa 213-0015, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Jimbo-Saito
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
authors.forename: Hiraku
authors.initials: H
authors.lastname: Kadoguchi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.forename: Shohei
authors.initials: S
authors.lastname: Nakanishi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Higa
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Katori
authors.forename: Fumi
authors.initials: F
authors.lastname: Takemoto
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nishimura
authors.forename: Michio
authors.initials: M
authors.lastname: Nakamura
authors.forename: Shinji
authors.initials: S
authors.lastname: Tomikawa
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ohashi
authors.forename: Kennmei
authors.initials: K
authors.lastname: Takaichi
mesh_terms: D000368:Aged; D001706:Biopsy; D001842:Bone and Bones / Q000503:physiopathology; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000473:pathology; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000601:surgery*; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications*; D016105:Parathyroidectomy / Q000379:methods; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000378:metabolism; D016896:Treatment Outcome