Tertiary hyperparathyroidism, a case report

Authors

Keywords:

HYPERPARATHYROIDISM, RENAL INSUFFICIENCY, CHRONIC KIDNEY DISEASE-MINERAL AND BONE DISORDER, PARATHYROID DISEASES.

Abstract

Introduction: the excess of biological hormonal activity of parathyroid origin is a frequent reason for consultation in endocrinological practice, although referrals from services such as nephrology, orthopedics or maxillofacial surgery are also referred due to the varied clinical presentations of the disease.

Case presentation: a 34-year-old female patient with a personal medical history of chronic renal failure. He went to the institution for presenting changes in his body appearance, especially at the level of the facial massif. The physical examination showed ostio-myo-articular alterations. The pelvic X-ray showed decreased bone density and diastasis of the pubic symphysis. Two-stage parathyroid scan detected parathyroid hyperplasia. Computed tomography of the skull showed marked bone destruction and resorption. Tertiary hyperparathyroidism was suggested.

Conclusions: tertiary hyperparathyroidism is one of the less frequent causes of parathyroid hyperfunction; It can occur as a consequence of a renal disorder that is perpetuated over time. Timely diagnosis and treatment decreases the incidence of comorbidities. Parathyroidectomy represents the treatment of choice, with high cure rates.

 
 

Downloads

Download data is not yet available.

References

1. Gordon S. The physiology of parathyroid hormone–related protein. N Engl J Med[Internet]. 2014[citado 01/02/2022]; 342(3): 177–185. Disponible en: https://www.nejm.org/doi/full/10.1056/nejm200001203420306

2. Alcaide M, Hernández E, Reyes S, Gallart T, García J, Sánchez M. Hiperparatiroidismo secundario. Actualización y revisión. Cirugía Andaluza [Internet]. 2020 [citado 01/02/2022]; 31(3):294-299. Disponible en: https://www.asacirujanos.com/admin/upfiles/revista/2020/Cir_Andal_vol31_n3_11.pdf

3. Balcázar-Hernández L, Rodríguez Manzo A, Vargas-Ortega G, Mendoza-Zubieta V, González-Virla B. Hiperparatiroidismo terciario como presentación de enfermedad ósea metabólica en trasplante renal: un reto diagnóstico-terapéutico. Presentación de un caso clínico. Rev Nefrol Dial Traspl [Internet]. 2021 [citado 01/02/2022]; 41(1):72-8. Disponible en: http://revistarenal.org.ar/index.php/rndt/article/view/620

4. Moreta Colcha HS, Paucar Llapapasca SD, Delgado Angamarca MJ, Merchán Saraguro DG. Hiperparatiroidismo secundario insuficiencia renal. RECIMUNDO [Internet]. 2020 [citado 01/02/2022]; 4(4): 282-290. https://doi.org/10.26820/recimundo/4.(4).octubre.2020.282-290

5. Hurtado Arias JJ, Peralta Amaro AL, García Ramírez C. Hiperparatiroidismo terciario posterior a un año del injerto renal exitoso. Rev Mex Traspl. [Internet]. 2021 [citado 01/02/2022]; 10(1):17-22. Disponible en: https://www.medigraphic.com/pdfs/trasplantes/rmt-2021/rmt211c.pdf

6. Albright F, Aub JC, Bauer W. Hyperparathyroidism: a common and polymorphic condition as illustrated by seventeen cases from one clinic. JAMA [Internet]. 1934 [citado 01/02/2022]; 102(6): 1276–1287. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/249530

7. Luján MA, Ramírez JA, Acevedo JM, Gómez S, Cañas JM, Santander D, et al. Prevalencia de las alteraciones del metabolismo óseo-mineral asociadas. Rev. colom. nefrol. [Internet]. 2019 [citado 01/02/2022]; 6(1):17-27. Disponible en: http://www.scielo.org.co/pdf/rcnef/v6n1/2500-5006-rcnef-6-01-17.pdf

8. Rodríguez MP. Hiperparatiroidismo asociado a la enfermedad renal crónica. Acta Med Colomb [Internet]. 2018 [citado 01/02/2022]; 43(3):126-128. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-24482018000300126&lng=en.

9. Sharma J, Weber C. Early versus late parathyroidectomy for tertiary (posttransplant) hyperparathyroidism, p. 209-16. En: Angelos P, Grogan RH. Difficult decisions in endocrine surgery: an evidence-based approach. Springer, 2018. Disponible en: http://doi.org/10.1007/978-3-319-92860-9

10. Thongprayoon C, Cheungpasitporn W. Persistent hyperparathyroidism after kidney transplantation; updates on the risk factors and its complications. J Parathyr Dis [Internet]. 2018 [citado 01/02/2022]; 6(1):26-8. Disponible en: http://doi.org/10.15171/jpd.2018.09

11. Sanint V, Restrepo CA, Chala AI. Experiencia con paratiroidectomía quirúrgica en pacientes con enfermedad renal crónica e hiperparatiroidismo terciario. Acta Med Colomb [Internet]. 2018 [citado 01/02/2022]; 43( 3 ): 136-141. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-24482018000300136&lng=en.

12. Vangala C, Pan J, Cotton RT, Ramanathan V. Mineral and bone disorders after kidney transplantation. Front Med(Lausenne) [Internet]. 2018 [citado 01/02/2022]; 5: 211. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079303/

13. Luzzi E, Boccalatte LA, Figari Marcelo F. Hiperparatiroidismo persistente: Doble foco hiperplásico intratímico post-paratiroidectomía total. Medicina (B. Aires) [Internet]. 2021 [citado 01/02/2022]; 81(1):127-127. Disponible en: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802021000100127&lng=es

Downloads

Published

2022-04-28

How to Cite

1.
Boffill-Carbó S, Torres-López Y, Godoy-Suárez JJ. Tertiary hyperparathyroidism, a case report. Rev Ciencias Médicas [Internet]. 2022 Apr. 28 [cited 2025 Aug. 10];26(3):e5518. Available from: https://revcmpinar.sld.cu/index.php/publicaciones/article/view/5518

Issue

Vol. 26 No. 3 (2022)

Section

CASE REPORTS

License

Authors who have publications with this journal agree to the following terms: Authors will retain their copyrights and grant the journal the right of first publication of their work, which will be publication of their work, which will be simultaneously subject to the Creative Commons Attribution License (CC-BY-NC 4.0) that allows third parties to share the work as long as its author and first publication in this journal are indicated.

Authors may adopt other non-exclusive license agreements for distribution of the published version of the work (e.g.: deposit it in an institutional telematic archive or publish it in a volume). Likewise, and according to the recommendations of the Medical Sciences Editorial (ECIMED), authors must declare in each article their contribution according to the CRediT taxonomy (contributor roles). This taxonomy includes 14 roles, which can be used to represent the tasks typically performed by contributors in scientific academic production. It should be consulted in monograph) whenever initial publication in this journal is indicated. Authors are allowed and encouraged to disseminate their work through the Internet (e.g., in institutional telematic archives or on their web page) before and during the submission process, which may produce interesting exchanges and increase citations of the published work. (See The effect of open access). https://casrai.org/credit/