title: Recurrent renal hyperparathyroidism due to parathyromatosis.
abstract: Parathyromatosis is the most severe type of recurrent secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX) in haemodialysis patients. It is difficult to completely remove all foci of parathyroid tissue and neck re-explorations are often required. Here, we report for the first time a case of recurrent SHPT due to parathyromatosis treated by radio-guided PTX. A haemodialysed 48-year-old woman with recurrent SHPT due to parathyromatosis was treated by radio-guided PTX. Preoperatively Ultrasonography, (99)Tc-SestaMIBI scintigraphy and magnetic resonances of the neck and thorax were performed. The preoperative imaging techniques detected four parathyroid nodules, while intraoperative gamma probe identified six nodules (three in atypical site). No frozen sections were performed during surgery. Post-operative intact parathyroid hormone levels were stabilized in the range 300-500 pg/mL during the 26 month follow-up by means of cinacalcet and paricalcitol therapy. In cases of parathyromatosis, the preoperative imaging techniques are inadequate, while intraoperative gamma probe is useful to detect the parathyroid tissue and allows a more extensive cytoreduction because it ensures the removal of undetectable and ectopic parathyroid foci. The operative time is reduced and frozen sections are unnecessary. However, the radio-guided PTX do not rule out parathyromatosis recurrence and complementary medical treatment is appropriate.
authors.affiliation: Istituto Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Carlo
authors.initials: C
authors.lastname: Vulpio
authors.affiliation: Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Giovanni
authors.initials: G
authors.lastname: D'Errico
authors.affiliation: Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Mattoli
authors.affiliation: Istituto Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bossola
authors.affiliation: Istituto Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Claudio
authors.initials: C
authors.lastname: Lodoli
authors.affiliation: Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Guido
authors.initials: G
authors.lastname: Fadda
authors.affiliation: Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Isabella
authors.initials: I
authors.lastname: Bruno
authors.affiliation: Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Istituto Clinica Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia.
authors.forename: Marco
authors.initials: M
authors.lastname: Castagneto
keywords: haemodialysis; parathyromatosis; radio-guided parathyroidectomy; secondary hyperparathyroidism