Krutak-Krol H, Mace C, Nichols W K, Singh A, Twardowski Z J
Department of Medicine, University of Missouri, Harry S. Truman Veterans Administration Hospital, Columbia.
Am J Nephrol. 1989;9(6):495-8. doi: 10.1159/000168019.
Persistent or recurrent hyperparathyroidism in patients with chronic renal failure may be a frustrating problem. We report a case history of a peritoneal dialysis patient who underwent total parathyroidectomy with autotransplantation for secondary hyperparathyroidism, developed tertiary hyperparathyroidism, and in an attempt to control hypercalcemia underwent seven partial resections of the autotransplant. Subsequently, a total excision of the parathyroid autograft was performed, but the patient continued to have hyperparathyroidism and unexpectedly was found to have a hyperplastic fifth parathyroid gland identified by thallium-technetium subtraction scan. The fifth gland was removed, and a part was implanted in the right forearm; however, the autoimplant had to be completely removed because of rapidly developing hypercalcemia. Hypercalcemia was controlled, but elevated levels of parathormone persisted. Remaining parathyroid tissue could not be found.
慢性肾衰竭患者持续性或复发性甲状旁腺功能亢进可能是一个令人沮丧的问题。我们报告一例腹膜透析患者的病史，该患者因继发性甲状旁腺功能亢进接受了甲状旁腺全切及自体移植手术，之后发展为三发性甲状旁腺功能亢进，为控制高钙血症，对自体移植的甲状旁腺进行了7次部分切除。随后，对甲状旁腺自体移植组织进行了全切，但患者仍有甲状旁腺功能亢进，经铊-锝减影扫描意外发现有一个增生的第五甲状旁腺。切除了第五甲状旁腺，并将一部分植入右前臂；然而，由于高钙血症迅速发展，不得不将自体移植组织完全切除。高钙血症得到控制，但甲状旁腺激素水平仍持续升高。未发现残留的甲状旁腺组织。
