Niel Olivier, Maisin Anne, Macher Marie-Alice, Peuchmaur Michel, Deschênes Georges
Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.
Inserm U1163, Molecular Pathways of Hereditary Kidney Diseases, Imagine Institute, 24, Boulevard du Montparnasse, 75015, Paris, France.
CEN Case Rep. 2016 Nov;5(2):141-143. doi: 10.1007/s13730-015-0211-0. Epub 2016 Jan 22.
Secondary hyperparathyroidism is often associated with end stage renal disease; even after renal transplantation, hyperparathyroidism may persist, and is responsible for hypercalcemia, hypophosphatemia and elevated parathyroid hormone (iPTH) levels. Parathyroid hyperplasia is frequently associated with persistent hyperparathyroidism, and may require a surgical treatment. Here, we report hyperparathyroidism along with parathyroid hyperplasia in a 7-year-old child, which persisted after renal transplant. Calcitonin and pamidronate failed to decrease serum calcium levels; clodronate was also inefficient. Cinacalcet therapy normalized serum calcium and phosphorus levels, and decreased iPTH levels in 3 months; a severe parathyroid hyperplasia was also corrected under calcimimetic therapy. In conclusion, we report in a child that hypercalcemia associated with secondary hyperparathyroidism can be corrected with cinacalcet after pediatric renal transplantation. We also show that parathyroid hyperplasia can regress under calcimimetic therapy in a transplanted child, making surgery unnecessary.
继发性甲状旁腺功能亢进常与终末期肾病相关；即使在肾移植后，甲状旁腺功能亢进仍可能持续存在，并导致高钙血症、低磷血症以及甲状旁腺激素（iPTH）水平升高。甲状旁腺增生常与持续性甲状旁腺功能亢进相关，可能需要手术治疗。在此，我们报告一名7岁儿童在肾移植后出现甲状旁腺功能亢进及甲状旁腺增生且持续存在的病例。降钙素和帕米膦酸未能降低血清钙水平；氯膦酸盐也无效。西那卡塞治疗在3个月内使血清钙和磷水平恢复正常，并降低了iPTH水平；在拟钙剂治疗下，严重的甲状旁腺增生也得到了纠正。总之，我们报告在一名儿童中，小儿肾移植后与继发性甲状旁腺功能亢进相关的高钙血症可用西那卡塞纠正。我们还表明，在移植儿童中，拟钙剂治疗可使甲状旁腺增生消退，从而无需进行手术。
