Atypical parathyroid adenoma in patient with chronic kidney disease. Case report and literature review

Atypical parathyroid adenoma is a rare cause of primary hyperparathyroidism (HPT). It can be diagnosed by morphological examination of the removed gland. In the published literature, We could not find any description of the primary HPT caused by atypical parathyroid adenoma in chronic kidney disease (CKD) in literature. Here we present a clinical observation of a young woman whose disease debuted with a hypertension (BP 210/130 mm Hg), proteinuria and high blood creatinine level (169 μmol/l, eGFR - 37 ml/min). Nephrobiopsy revealed focal global and segmental glomerulosclerosis. CKD stage 3 has been diagnosed, nephroprotective therapy was recommended. Blood biochemical examination after 8 years (before pregnancy): creatinine level - 156 μmol/l (eGFR 40 ml/min), ionized calcium and phosphorus 1.37 and 1.01 mmol/l, parathyroid hormone (PTH) 91 pg/ml. Neck ultrasound revealed no additional mass in the projection of the parathyroid glands (PG). After another year during pregnancy, creatinine was 137 μmol/l, total calcium corrected for serum albumin - 2.89 mmol/l, PTH - 47 pg/ml. CKD progressed after successful delivery, patient started of peritoneal dialysis treatment. PTH was 1613 pg/ml, calcium - 2.92-2.67 mmol/l, phosphorus - 2.12 mmol/l, alkaline phosphatase activity - 857 U/l (normal 3-258). Neck ultrasound a mass (26×15×13 mm) in the right lower PG. Selective parathyroidectomy was performed. Morphological study: a tumor node from the main cells with trabecular and perivascular rosette-like structures; a thick fibrous capsule with foci of tumor complexes; increased mitotic activity. Diffuse intense expression of PTH and proliferation index Ki-67=10% found in the immunohystochemical study. Conclusion: atypical parathyroid adenoma (pTisNx in accordance with American Joint Committee on Cancer, 2017). The protracted «hunger bone» syndrome was observed in the postoperative period. A brief clinical, biochemical and morphological characteristics of the atypical parathyroid adenoma are presented.

хроническая болезнь почек, первичный гиперпаратиреоз, атипическая аденома околощитовидной железы, синдром «голодной кости», chronic kidney disease, primary hyperparathyroidism, atypical parathyroid adenoma, «hungry bone» syndrome

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