A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease

Xia Qing Li; Kai Jun Chen; Yu Meng

doi:doi:10.11648/j.sjcm.20211002.15

| Peer-Reviewed

A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease

Xia Qing Li, Kai Jun Chen, Yu Meng

Published in Science Journal of Clinical Medicine (Volume 10, Issue 2)

Received: 18 May 2021 Accepted: 30 May 2021 Published: 10 June 2021

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Parathyroidectomy (PTX) is the definitive treatment of primary hyperparathyroidism (PHPT) for symptomatic patients. PTX for hyperparathyroidism is associated with the risk of recurrence; however, this has been mostly demonstrated in chronic kidney disease (CKD) patients with secondary hyperparathyroidism. The recurrent risk of hyperparathyroidism and renal outcomes after PTX in patients with PHPT has been rarely reported. Patient: In this article, we report a case of a 70-year-old man with previously diagnosed CKD, underwent a subtotal PTX for asymptomatic primary hyperparathyroidism induced by parathyroid hyperplasias. The PTX appears to resolve the calcium disturbance in this patient. However, at three months after the surgery, the diagnosis of recurrent hyperparathyroidism was made, based on a remarkably increased level of parathyroid hormone from 42.12 pg/ml to 270.9 pg/ml. Over 2 years of follow-up, his renal function, as evaluated by serum creatinine levels, fluctuated modestly, but persist at a preoperative level of renal impairment. These data indicate that this patient with asymptomatic PHPT has experienced recurrent hyperparathyroidism with persistent renal dysfunction after PTX. Conclusion: The recurrent hyperparathyroidism after PTX in PHPT patients with a coexisting renal impairment appears more common than might be anticipated. We recommend that if hyperparathyroidism recurs or exacerbates by the persistent renal dysfunction after PTX, the potential benefits of PTX should be reconsidered and carefully weighed against the possible surgical risks.

Published in	Science Journal of Clinical Medicine (Volume 10, Issue 2)
DOI	10.11648/j.sjcm.20211002.15
Page(s)	42-46
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Hyperparathyroidism, Parathyroidectomy, Chronic Kidney Disease

References

[1]	C. Y. Zhu, C. Sturgeon, M. W. Yeh, Diagnosis and Management of Primary Hyperparathyroidism, JAMA. 2020 Mar 24; 323 (12): 1186-1187.
[2]	R. A. DeLellis, P. Mazzaglia, S. Mangray, Primary hyperparathyroidism: a current perspective, Arch Pathol Lab Med. 2008 Aug; 132 (8): 1251-1262.
[3]	E. A. Alore, J. W. Suliburk, D. J. Ramsey, et al., Diagnosis and Management of Primary Hyperparathyroidism Across the Veterans Affairs Health Care System, JAMA Intern Med. 2019 Jul 15.
[4]	F. Tassone, A. Guarnieri, E. Castellano, et al., Parathyroidectomy Halts the Deterioration of Renal Function in Primary Hyperparathyroidism, J Clin Endocrinol Metab. 2015 Aug; 100 (8): 3069-3073.
[5]	S. M. Wilhelm, T. S. Wang, D. T. Ruan, et al., The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism, JAMA Surg. 2016 Oct 1; 151 (10): 959-968.
[6]	K. Zanocco, P. Angelos, C. Sturgeon, Cost-effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism, Surgery. 2006 Dec; 140 (6): 874-881; discussion 881-872.
[7]	C. Verdelli, S. Corbetta, MECHANISMS IN ENDOCRINOLOGY: Kidney involvement in patients with primary hyperparathyroidism: an update on clinical and molecular aspects, Eur J Endocrinol. 2017 Jan; 176 (1): R39-R52.
[8]	K. Bruck, V. S. Stel, G. Gambaro, et al., CKD Prevalence Varies across the European General Population, J. Am. Soc. Nephrol. 2016 Jul; 27 (7): 2135-2147.
[9]	2015 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, 2015.
[10]	C. C. Liang, H. C. Yeh, Y. C. Lo, et al., Parathyroidectomy slows renal function decline in patients with primary hyperparathyroidism, J. Endocrinol. Invest. 2021 Apr; 44 (4): 755-763.
[11]	R. S. Sippel, J. Bianco, H. Chen, Radioguided parathyroidectomy for recurrent hyperparathyroidism caused by forearm graft hyperplasia, J Bone Miner Res. 2003 May; 18 (5): 939-942.
[12]	N. Lin, Y. Fang, C. Yu, et al., A useful treatment for recurrent secondary hyperparathyroidism after Parathyroidectomy: A case report, Asian J Surg. 2020 Apr; 43 (4): 573-574.
[13]	J. Stratton, M. Simcock, H. Thompson, et al., Predictors of recurrent hyperparathyroidism after total parathyroidectomy in chronic renal failure, Nephron Clin Pract. 2003 95 (1): c15-22.
[14]	D. J. McMahon, A. Carrelli, N. Palmeri, et al., Effect of Parathyroidectomy Upon Left Ventricular Mass in Primary Hyperparathyroidism: A Meta-Analysis, J Clin Endocr Metab. 2015 Dec; 100 (12): 4399-4407.
[15]	C. Dural, A. K. Okoh, A. Seicean, et al., A pilot study investigating the effect of parathyroidectomy on arterial stiffness and coronary artery calcification in patients with primary hyperparathyroidism, Surgery. 2016 Jan; 159 (1): 218-224.
[16]	F. Zheng, H. Zhou, N. Li, et al., Skeletal effects of failed parathyroidectomy, Surgery. 2018 Jan; 163 (1): 17-21.
[17]	C. G. Nair, M. Babu, P. Jacob, et al., Renal dysfunction in primary hyperparathyroidism; effect of Parathyroidectomy: A retrospective Cohort Study, Int J Surg. 2016 Dec; 36 (Pt A): 383-387.
[18]	M. Peacock, Primary hyperparathyroidism and the kidney: biochemical and clinical spectrum, J Bone Miner Res. 2002 Nov; 17 Suppl 2 N87-94.
[19]	M. Belli, R. M. Martin, M. D. G. Brescia, et al., Acute and long-term kidney function after parathyroidectomy for primary hyperparathyroidism, PLoS One. 2020 15 (12): e0244162.
[20]	R. J. Egan, F. Dewi, R. Arkell, et al., Does elective parathyroidectomy for primary hyperparathyroidism affect renal function? A prospective cohort study, Int J Surg. 2016 Mar; 27 138-141.

Cite This Article

Plain Text BibTeX RIS

APA Style

Xia Qing Li, Kai Jun Chen, Yu Meng. (2021). A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease. Science Journal of Clinical Medicine, 10(2), 42-46. https://doi.org/10.11648/j.sjcm.20211002.15

Copy | Download

ACS Style

Xia Qing Li; Kai Jun Chen; Yu Meng. A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease. Sci. J. Clin. Med. 2021, 10(2), 42-46. doi: 10.11648/j.sjcm.20211002.15

Copy | Download

AMA Style

Xia Qing Li, Kai Jun Chen, Yu Meng. A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease. Sci J Clin Med. 2021;10(2):42-46. doi: 10.11648/j.sjcm.20211002.15

Copy | Download

@article{10.11648/j.sjcm.20211002.15,
  author = {Xia Qing Li and Kai Jun Chen and Yu Meng},
  title = {A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease},
  journal = {Science Journal of Clinical Medicine},
  volume = {10},
  number = {2},
  pages = {42-46},
  doi = {10.11648/j.sjcm.20211002.15},
  url = {https://doi.org/10.11648/j.sjcm.20211002.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20211002.15},
  abstract = {Background: Parathyroidectomy (PTX) is the definitive treatment of primary hyperparathyroidism (PHPT) for symptomatic patients. PTX for hyperparathyroidism is associated with the risk of recurrence; however, this has been mostly demonstrated in chronic kidney disease (CKD) patients with secondary hyperparathyroidism. The recurrent risk of hyperparathyroidism and renal outcomes after PTX in patients with PHPT has been rarely reported. Patient: In this article, we report a case of a 70-year-old man with previously diagnosed CKD, underwent a subtotal PTX for asymptomatic primary hyperparathyroidism induced by parathyroid hyperplasias. The PTX appears to resolve the calcium disturbance in this patient. However, at three months after the surgery, the diagnosis of recurrent hyperparathyroidism was made, based on a remarkably increased level of parathyroid hormone from 42.12 pg/ml to 270.9 pg/ml. Over 2 years of follow-up, his renal function, as evaluated by serum creatinine levels, fluctuated modestly, but persist at a preoperative level of renal impairment. These data indicate that this patient with asymptomatic PHPT has experienced recurrent hyperparathyroidism with persistent renal dysfunction after PTX. Conclusion: The recurrent hyperparathyroidism after PTX in PHPT patients with a coexisting renal impairment appears more common than might be anticipated. We recommend that if hyperparathyroidism recurs or exacerbates by the persistent renal dysfunction after PTX, the potential benefits of PTX should be reconsidered and carefully weighed against the possible surgical risks.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease
AU  - Xia Qing Li
AU  - Kai Jun Chen
AU  - Yu Meng
Y1  - 2021/06/10
PY  - 2021
N1  - https://doi.org/10.11648/j.sjcm.20211002.15
DO  - 10.11648/j.sjcm.20211002.15
T2  - Science Journal of Clinical Medicine
JF  - Science Journal of Clinical Medicine
JO  - Science Journal of Clinical Medicine
SP  - 42
EP  - 46
PB  - Science Publishing Group
SN  - 2327-2732
UR  - https://doi.org/10.11648/j.sjcm.20211002.15
AB  - Background: Parathyroidectomy (PTX) is the definitive treatment of primary hyperparathyroidism (PHPT) for symptomatic patients. PTX for hyperparathyroidism is associated with the risk of recurrence; however, this has been mostly demonstrated in chronic kidney disease (CKD) patients with secondary hyperparathyroidism. The recurrent risk of hyperparathyroidism and renal outcomes after PTX in patients with PHPT has been rarely reported. Patient: In this article, we report a case of a 70-year-old man with previously diagnosed CKD, underwent a subtotal PTX for asymptomatic primary hyperparathyroidism induced by parathyroid hyperplasias. The PTX appears to resolve the calcium disturbance in this patient. However, at three months after the surgery, the diagnosis of recurrent hyperparathyroidism was made, based on a remarkably increased level of parathyroid hormone from 42.12 pg/ml to 270.9 pg/ml. Over 2 years of follow-up, his renal function, as evaluated by serum creatinine levels, fluctuated modestly, but persist at a preoperative level of renal impairment. These data indicate that this patient with asymptomatic PHPT has experienced recurrent hyperparathyroidism with persistent renal dysfunction after PTX. Conclusion: The recurrent hyperparathyroidism after PTX in PHPT patients with a coexisting renal impairment appears more common than might be anticipated. We recommend that if hyperparathyroidism recurs or exacerbates by the persistent renal dysfunction after PTX, the potential benefits of PTX should be reconsidered and carefully weighed against the possible surgical risks.
VL  - 10
IS  - 2
ER  -

Copy | Download

Author Information

Xia Qing Li

Department of Nephrology, the First Hospital Affiliated to Jinan University, Guangzhou, China
Kai Jun Chen

Department of Nephrology, People's Hospital of Longchuan County, Heyuan, China
Yu Meng

Department of Nephrology, the First Hospital Affiliated to Jinan University, Guangzhou, China

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Xia Qing Li, Kai Jun Chen, Yu Meng. (2021). A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease. Science Journal of Clinical Medicine, 10(2), 42-46. https://doi.org/10.11648/j.sjcm.20211002.15

Copy | Download

ACS Style

Xia Qing Li; Kai Jun Chen; Yu Meng. A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease. Sci. J. Clin. Med. 2021, 10(2), 42-46. doi: 10.11648/j.sjcm.20211002.15

Copy | Download

AMA Style

Xia Qing Li, Kai Jun Chen, Yu Meng. A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease. Sci J Clin Med. 2021;10(2):42-46. doi: 10.11648/j.sjcm.20211002.15

Copy | Download

@article{10.11648/j.sjcm.20211002.15,
  author = {Xia Qing Li and Kai Jun Chen and Yu Meng},
  title = {A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease},
  journal = {Science Journal of Clinical Medicine},
  volume = {10},
  number = {2},
  pages = {42-46},
  doi = {10.11648/j.sjcm.20211002.15},
  url = {https://doi.org/10.11648/j.sjcm.20211002.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20211002.15},
  abstract = {Background: Parathyroidectomy (PTX) is the definitive treatment of primary hyperparathyroidism (PHPT) for symptomatic patients. PTX for hyperparathyroidism is associated with the risk of recurrence; however, this has been mostly demonstrated in chronic kidney disease (CKD) patients with secondary hyperparathyroidism. The recurrent risk of hyperparathyroidism and renal outcomes after PTX in patients with PHPT has been rarely reported. Patient: In this article, we report a case of a 70-year-old man with previously diagnosed CKD, underwent a subtotal PTX for asymptomatic primary hyperparathyroidism induced by parathyroid hyperplasias. The PTX appears to resolve the calcium disturbance in this patient. However, at three months after the surgery, the diagnosis of recurrent hyperparathyroidism was made, based on a remarkably increased level of parathyroid hormone from 42.12 pg/ml to 270.9 pg/ml. Over 2 years of follow-up, his renal function, as evaluated by serum creatinine levels, fluctuated modestly, but persist at a preoperative level of renal impairment. These data indicate that this patient with asymptomatic PHPT has experienced recurrent hyperparathyroidism with persistent renal dysfunction after PTX. Conclusion: The recurrent hyperparathyroidism after PTX in PHPT patients with a coexisting renal impairment appears more common than might be anticipated. We recommend that if hyperparathyroidism recurs or exacerbates by the persistent renal dysfunction after PTX, the potential benefits of PTX should be reconsidered and carefully weighed against the possible surgical risks.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease
AU  - Xia Qing Li
AU  - Kai Jun Chen
AU  - Yu Meng
Y1  - 2021/06/10
PY  - 2021
N1  - https://doi.org/10.11648/j.sjcm.20211002.15
DO  - 10.11648/j.sjcm.20211002.15
T2  - Science Journal of Clinical Medicine
JF  - Science Journal of Clinical Medicine
JO  - Science Journal of Clinical Medicine
SP  - 42
EP  - 46
PB  - Science Publishing Group
SN  - 2327-2732
UR  - https://doi.org/10.11648/j.sjcm.20211002.15
AB  - Background: Parathyroidectomy (PTX) is the definitive treatment of primary hyperparathyroidism (PHPT) for symptomatic patients. PTX for hyperparathyroidism is associated with the risk of recurrence; however, this has been mostly demonstrated in chronic kidney disease (CKD) patients with secondary hyperparathyroidism. The recurrent risk of hyperparathyroidism and renal outcomes after PTX in patients with PHPT has been rarely reported. Patient: In this article, we report a case of a 70-year-old man with previously diagnosed CKD, underwent a subtotal PTX for asymptomatic primary hyperparathyroidism induced by parathyroid hyperplasias. The PTX appears to resolve the calcium disturbance in this patient. However, at three months after the surgery, the diagnosis of recurrent hyperparathyroidism was made, based on a remarkably increased level of parathyroid hormone from 42.12 pg/ml to 270.9 pg/ml. Over 2 years of follow-up, his renal function, as evaluated by serum creatinine levels, fluctuated modestly, but persist at a preoperative level of renal impairment. These data indicate that this patient with asymptomatic PHPT has experienced recurrent hyperparathyroidism with persistent renal dysfunction after PTX. Conclusion: The recurrent hyperparathyroidism after PTX in PHPT patients with a coexisting renal impairment appears more common than might be anticipated. We recommend that if hyperparathyroidism recurs or exacerbates by the persistent renal dysfunction after PTX, the potential benefits of PTX should be reconsidered and carefully weighed against the possible surgical risks.
VL  - 10
IS  - 2
ER  -

Copy | Download