A case report of a bone histomorphometrical analysis after a total parathyroidectomy.
A patient with secondary hyperparathyroidism (2 degrees HPT) underwent a total parathyroidectomy (PTx) without autotransplantation and showed interesting changes in the morphology of his iliac bone before and after the surgery. A 70-year-old man had been on hemodialysis for chronic glomerulonephritis since 1987. He had been administered calcium carbonate 6.0 g daily to prevent reabsorption of phosphorus and alfacalcidol 1.0 microg three times weekly at the end of hemodialysis. In September 2000, his intact parathyroid hormone (iPTH; 1-84 PTH) was 610 pg/mL; therefore, from 2.5 microg to 10 microg 22-oxacalcitriol (maxacalcitol, a derivative of active vitamin D) was administered intravenously three times weekly at the end of hemodialysis. This compound is used in Japan for 2 degrees HPT. However, the iPTH progressed, and hypercalcemia and hyperphosphatemia were observed. Ultrasonography of the neck illustrated three enlarged parathyroid glands that were each over 1.0 cm in diameter. On 14 July 2004, a PTx without autotransplantation (PTx alone) and an iliac crest bone biopsy were performed. Bone specimens showed mild lesions of hyperparathyroidism, but did not meet the criteria for osteitis fibrosa. One year after the procedure, a second biopsy was obtained to investigate the bone turnover in response to a lack of parathyroid hormone. The bone specimen showed tetracycline labeling at the time of PTx alone, and new bone apposition on the surface without tetracycline labeling. This adynamic bone disease (ABD) suggested that new bone apposition in the absence of tetracycline labeling had occurred after the PTx alone, and it had likely occurred over the course of one year.
Yajima
Ibuki
I
Urology, Ibuki Clinic, Osaka, Japan. iy-hd-pd@kf7.so-net.ne.jp
Tanizawa
Tatsuhiko
T
Yamamoto
Noriyuki
N
Fukuda
Toyoshi
T
Higashi
Tokio
T
Tabata
Sakuyoshi
S
Yao
Ryoji
R
Yamato
Hideyuki
H
Murayama
Hisashi
H
D000368:Aged; D001706:Biopsy; D001847:Bone Diseases / Q000209:etiology* / Q000473:pathology; D002908:Chronic Disease; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000628:therapy; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D007085:Ilium / Q000473:pathology; D008297:Male; D016105:Parathyroidectomy / Q000379:methods*; D006435:Renal Dialysis