Abstract
Secondary hyperparathyroidism (2°HPT) is one of the most important complications in chronic dialysis patients. A 58-year-old hemodialysis patient, who had suffered from severe 2°HPT for several years, suddenly developed severe hypocalcemia. The serum parathyroid hormone (PTH) level decreased gradually after this episode. Thereafter the serum calcium value was gradually increased by the administration of vitamin D and calcium carbonate, and the low serum PTH level persisted. A follow-up computed tomography scan revealed that the formerly enlarged parathyroid gland was markedly reduced in volume. Therefore, necrosis of an enlarged parathyroid gland, probably due to infarction, is considered to be a trigger for hypocalcemia. About 30 cases cf spontaneous remission of primary hyperparathyroidism due to the necrosis of parathyroid adenoma have been reported. It is suggested from the present case that an abrupt onset of severe hypocalcemia in association with a decreased PTH might occur in patients with severe hyperparathyroidism, indicating a necrosis of the gland.
