Abstract
A 44-year-old man noticed purpura on his lower legs in Feb. 2008. One or two weeks before, he experienced very severe pain in his lower legs. The purpura turned into necrosis and ulcers. There were no infection. He consulted a plastic surgeon because his skin necrosis and ulcers were difficult to treat. The plastic surgeon resected the lesions and substituted the resected area with skin grafts eight times. In June 2008, He underwent resection of 4 parathyroids. He also received on operation of minced parathyroid autografts on his right forearm. After parathyroidectomy, the necrosis and ulcers attenuated. The histological findings supported the clinical course of our CUA case. Recently, research on the pathophysiology of calcification in the mid-membrane of arterioles has made marked progress. Phosphatemia transforms vascular smooth muscle cells into osteogenic cells producing osteocalcin, which combine with Ca2+. Consequently, active de novo calcification in the mid-membrane of arterioles occurs. We presented a new idea for a CUA mechanism concerning controversial reports about parathyroidectomy. The essential point is to maintain the dynamic turnover of bone remodeling. The effect of cinacalcet against CUA supports this idea. New treatments for CUA are also emerging. In the near future, parathyroidectomy will be replaced by STS and cinacalcet.
