Yeh Chun-Tung, Lin Yao-Ping, Yang Wu-Chang, Yang An-Han, Lai Ming-Yu, Lin Chih-Ching
Division of Nephrology, department of Medicine, Taipei, Taiwan.
Am J Med Sci. 2006 May;331(5):284-7. doi: 10.1097/00000441-200605000-00011.
A 42-year-old woman underwent hemodialysis secondary to diabetic nephropathy. Total parathyroidectomy with forearm autograft was performed due to secondary hyperparathyroidism (HPT) complicated with calciphylaxis. Rapidly progressive enlargement of autograft with unusual "gourd-shape" developed, and then it was removed. Pathologic examination of the autograft disclosed multinodular hyperplasia. Residual parathyroid gland in the retrothyroid region was found later. Rapidly recurrent HPT originating from both the residual parathyroid tissues and the enlarged autograft within such short time after parathyroidectomy is rare in the literature. The multinodular hyperplasia pattern of the parathyroid gland may be a major factor for such rapid recurrence. In addition to good control of calcium and phosphate, regular follow-up of parathyroid hormone level and imaging studies of not only autografted gland at the forearm but also possibly residual parathyroid tissues at the neck are important for monitoring recurrence in maintenance hemodialysis patients after parathyroidectomy with forearm autograft, especially in those with pathologic type of nodular hyperplasia and calciphylaxis.
一名42岁女性因糖尿病肾病接受血液透析。由于继发性甲状旁腺功能亢进（HPT）并发钙化防御，进行了甲状旁腺全切术并在前臂进行自体移植。自体移植组织迅速进展性增大，呈不寻常的“葫芦形”，随后将其切除。对自体移植组织的病理检查显示为多结节性增生。后来在甲状腺后区域发现了残留的甲状旁腺组织。甲状旁腺切除术后如此短的时间内，残余甲状旁腺组织和增大的自体移植组织均迅速复发HPT，这在文献中较为罕见。甲状旁腺的多结节性增生模式可能是这种快速复发的主要因素。除了良好地控制钙和磷水平外，定期随访甲状旁腺激素水平，不仅对前臂自体移植腺体进行影像学检查，还可能对颈部残余甲状旁腺组织进行检查，对于监测接受前臂自体移植甲状旁腺切除术后维持性血液透析患者的复发情况很重要，尤其是对于那些具有结节性增生病理类型和钙化防御的患者。
