Surgical treatment of recurrent tertiary hyperparathyroidism caused by widespread parathyromatosis (Case report and literature review)

Relevance. Diffuse parathyromatosis is a rare ethiological factor of renal hyperparathyroidism. Its diagnostics and treatment are extremely difficult. Efficiency and feasibility of its surgical treatment are questioned. Several conservative approaches are considered as an alternative to surgery, although their efficiency and economic viability has not been confirmed so far. A review of the literature and our own experience of surgical treatment of this rare disease are provided as well as discussion of the treatment and diagnostic tactics. Materials and Methods. A female patient (age 54, hemodialysis for 12 years) who underwent subtotal parathyroidectomy was followed up. A recurrence of the disease occurred in 2 years after the surgery. The differential diagnosis between cancer and parathyromatosis was performed using computed tomography, scintigraphy, histological examination. The final diagnosis was made after the operation, which included wide excision of involved parathyromatosis tissues. Results. Operation efficiency was confirmed by a decrease in parathyroid hormone from 2350 pg/ml (before operation) to 31 pg/ml. The patient was successfully discharged without surgical complications; 1.5 months after surgery the intact parathyroid hormone level increased to 125 pg/ml in the absence of treatment of hypocalcemia. After 2.5 months of adequate therapy with vitamin D and Ca calcium and phosphorus levels were normalized. Conclusions. A total parathyroidectomy followed by dissection of neck fatty tissue and upper mediastinum can be considered as a way of prevention of secondary parathyromatosis. This approach may become the basis of an effective surgical treatment provided adequate correction of bone mineral metabolism in the postoperative period.

паратиреоматоз, вторичный гиперпаратиреоз, третичный гиперпаратиреоз, паратиреоидэктомия, parathyromatosis, secondary hyperparathyroidism, tertiary hyperparathyroidism, parathyroidectomy

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