Abstract
A 49-year-old female presented with multiple bone and joint pain in spring 1989, but a diagnosis of hyperparathyroidism was not made. Hemodialysis was started in May 1991 for chronic renal failure due to chronic glomerulonephritis. At the beginning of dialysis, marked bone resorption in x-ray pictures and high serum alkaline phosphatase and parathyroid hormone (PTH) were noted. CT examination revealed a huge right lower parathyroid gland confirmed by scintigraphy. Preoperative examination revealed intact-PTH of 1, 199pg/ml (normal range: 15-50pg/ml), C-PTH of 34.2ng/ml (normal less than 0.5ng/ml), and Al-P of 443IU/l. Intact-PTH was not suppressed by hypercalcemia (s-Ca 12.7mg/dl) during hemodialysis (intact-PTH 810→800pg/ml), suggesting automatism of parathyroid function. After subtotal parathyroidectomy removing 5.65g of parathyroid gland, serum PTH fell rapidly. On histological examination, the right lower parathyroid gland revealed a carcinoma consisting mainly of extended fibrous trabeclae and cells with large nuclei and multiple nucleoli.
