A case of early recurrence of renal hyperparathyroidism caused by autograft growth following total parathyroidectomy with autotransplantation

Abstract

The patient was a 58-year-old woman who had been undergoing dialysis at a local clinic for chronic renal failure caused by diabetic nephropathy. From November 2005 a rapid increase in serum intact PTH levels was observed, and the patient was referred to our department as her condition could not be managed at the Department of Internal Medicine. Based on further tests, surgery was indicated for secondary hyperparathyroidism, and the patient underwent total parathyroidectomy with autotransplantation into muscles in the right forearm (PTx) in December 2005. Although the postoperative course was favorable, serum intact PTH levels increased again from around October 2007 and a tumor gradually formed on the transplantation site on the right forearm. The patient returned to our department after her serum intact PTH exceeded 700 pg/ml in April 2008. No remnants of the ectopic parathyroid gland were observed, and serum intact PTH levels in blood collected from the right (operated) arm was 19300 pg/ml, which was approximately 16-fold greater than that for the left arm. The patient was thus diagnosed with recurrence caused by autograft growth and underwent resection under local anesthesia. Serum intact PTH levels rapidly returned to normal following surgery. We report the present case of recurrence occurring approximately two years after PTx with reference to literature.