Clinical profile and outcome of primary hyperparathyroidism accompanied by chronic renal failure
Mizumoto, D.; Watanabe, Y.; Fukuzawa, Y.; Aoi, N.; Yamazaki, C.
Clinical Nephrology 42(5): 315-321
1994
ISSN/ISBN: 0301-0430 PMID: 7851033 Document Number: 428951
We encountered 5 cases of primary hyperparathyroidism (PHPT) accompanied by chronic renal failure over the past 4 years. Neither hypocalcemia nor hyperphosphatemia was found in the past records. The parathyroid hormone (PTH) levels in these cases were extraordinarily higher than those in usual patients suffering from renal failure. The manifestation of PHPT developed insidiously together with the decline of renal function. Serum 1,25(OH)-2D-3 levels were lower than normal range in all cases, and which in turn might accelerate the progression of PHPT in a similar way as the development of secondary hyperparathyroidism. Parathyroidectomy (PTX) was done successfully in 4 cases, and the pathology of the biggest gland was adenoma but hyperplasia was found in other glands simultaneously. These results revealed the polymorphism of parathyroid glands in case of complication with renal failure. Furthermore, the interruption of postoperative 1-alpha(OH)D-3 treatment induced the relapse of hyperparathyroidism (HPT). The case which refused PTX was treated by oral pulse therapy with 1,25(OH)-2D-3. The calcium/intact PTH sigmoidal curve examined 3 years later revealed that the set point shifted to right and upward despite therapy. It suggested that functional parathyroid mass became larger and the sensitivity to calcium became less under continuous stimuli on parathyroid glands. According to these results, PHPT accompanying with renal failure is resistant to medical therapy, and surgical treatment is a possibility. In this occasion, total PTX with autograft transplantation is better than simple adenectomy because even the glands not responsible to clinical manifestation of PHPT can have some pathological abnormalities. Though the incidence rate of overt HPT in our institutes was low at pre-dialysis stage (0.2%, 10/582), a detailed individual review of patients records might facilitate a differential diagnosis as to whether HPT is primary or secondary, and might help to select a precise therapeutic method.