Unbehaun R, Lauerwald W
Nephrologische Gemeinschaftspraxis, Gera, Germany.
Clin Nephrol. 2007 Mar;67(3):188-92. doi: 10.5414/cnp67188.
We present the case of a 65-year-old male on long-term dialysis for end-stage renal failure, who developed persistent secondary hyperparathyroidism after subtotal parathyroidectomy, which proved refractory to treatment. Parathyromatosis, a rare cause of recurrent hyperparathyroidism, which may develop when tissue seeded into the neck during subtotal or total parathyroidectomy becomes hyperfunctioning [Maxwell and Winearls 1997], was diagnosed. The patient had excessively high levels of circulating parathyroid hormone (PTH), elevated serum calcium and deteriorating cardiovascular status. Repeated surgery and treatment with high-dose vitamin D failed to provide a sustained decrease in serum PTH levels. Administration of cinacalcet HCl, a second generation calcimimetic, at doses of 30 - 180 mg/day provided a gradual and sustained suppression of PTH (> 1,700 - 344 ng/l) without increasing the calcium-phosphate product.
我们报告了一例65岁男性，因终末期肾衰竭接受长期透析治疗，在次全甲状旁腺切除术后出现持续性继发性甲状旁腺功能亢进，且治疗无效。甲状旁腺增生症是复发性甲状旁腺功能亢进的一种罕见病因，当在次全或全甲状旁腺切除术中种植于颈部的组织功能亢进时可能会发生[Maxwell和Winearls，1997年]，该病例被诊断为此病。患者循环甲状旁腺激素（PTH）水平过高，血清钙升高，心血管状况恶化。重复手术和大剂量维生素D治疗均未能使血清PTH水平持续下降。给予第二代拟钙剂盐酸西那卡塞，剂量为30 - 180毫克/天，可逐渐且持续地抑制PTH（>1700 - 344纳克/升），而不会增加钙磷乘积。
