Introducción: La mayoría de los pacientes con enfermedad renal crónica terminal en hemodiálisis desarrollan hiperparatiroidismo secundario. Algunas veces este tipo de hiperparatiroidismo secundario suele ser severo y refractario al tratamiento médico, inclusive algunos desarrollarán hiperparatiroidismo terciario, el tratamiento de ambas situaciones suele ser la paratiroidectomía subtotal o total. Reporte de Caso: Presentamos el caso de un paciente de 29 años, con enfermedad renal terminal en hemodiálisis durante 13 años, quien desarrolló hiperparatiroidismo terciario por lo que fue sometido a paratiroidectomía subtotal con autotrasplante de media glándula; el estudio patológico informó la presencia de un carcinoma de paratiroides en una de las cuatro glándulas paratiroides extirpadas. Conclusión: El carcinoma de paratiroides es una neoplasia rara que causa hiperparatiroidismo primario en menos de 1% de todos los casos, y se ha reportado en algunos pacientes operados por hiperparatiroidismo terciario.

Backrgound: To estimate the accuracy of metabolic syndrome definitions for detecting Carotid Intima-Media thickness (CIMT) in Peruvian type 2 diabetes mellitus (T2DM) subjects without cardiovascular events.Methods: We performed a cross-sectional evaluation of T2DM subjects from the endocrinology service of two reference health centers without stroke or coronary disease. . Bilateral carotid intima-media thickness was measure by B mode ultrasound one only operator. We performed four definitions of Metabolic Syndrome; 1. Cholesterol Education Program Adult Treatment Panel III (ATP III), 2. Harmonized criteria; 3. Gurka's Metabolic syndrome severity score (MSSS) formula. 4. Non-glucose modified MSSS. We calculated the area under the receiver operator curve (AUROC) for detecting increased CIMT (≥ 0.86 mm) between metabolic syndrome definitions. Results: We included 184 subjects with T2DM, 29% were men with a mean age of 61.5 ± 10.5 years old. Median diabetes time was 10.8 years (IQR 4.8 to 19.4), and 26.8% achieved HbA1c goals. Non-glucose modified MSSS was the only definition significantly correlated with elevated CIMT (r = 0.19; p<0.01), and it showed the best accuracy for predicting elevated CIMT (AUC: 0.61, CI95%: 0.52-0.70). Adjusting for age, sex, and HbA1c, each point increase in the non-glucose MSSS Z score, the risk of altered CIMT increases by 59% RP 1.59 (CI 95% 1.09 - 2.35; p=0.017). Conclusions: Non-glucose modified MSSS had a weak accuracy for elevated CIMT and was the best compared to ATP III, harmonized, and original MSSS. Further research on no MS-factors is required to predict better elevated CIMT.