Mediastinal Parathyroid Carcinoma in A Patient with Chronic Kidney Disease in Hemodialysis

Abstract

Background: Parathyroid carcinoma accounts for 0.5-5% of primary hyperparathyroidism, and is exceptional in Chronic Kidney Disease. It usually presents with Hypercalcemia and increased PTH. Image studies with 99Tc-sestaMIBI scintigraphy and ultrasonography are first line. Histopathological features and negative immunohistochemistry staining for parafibromin provide the definitive diagnosis. Summary:A 49-year-old male with stage 5 CKD presented with Hypercalcemia and a rapid rise in PTH levels. Image studies showed signs of parathyroid hyperplasia. After subtotal parathyriodectomy, intraoperative PTH levels did not fall, and a fifth ectopic gland in the mediastinum was resected. Biopsies were consistent with parathyroid carcinoma. Conclusion:Parathyroid carcinoma is an infrequent pathology in CKD, and should be considered in patients with sudden rises in calcium and/or PTH levels. Image studies are highly sensitive, but false negatives exist. Unsatisfactory decreases in intraoperative PTH levels suggest an ectopic gland, and may provide the key to a successful surgery.

Prikaz slučaja karcinoma paratiroidne žlezde kod pacijenata sa hroničnom bubrežnom insuficijencijom

“…U proseku, kod pacijenata na HD vrednosti serumskog PTH kreću se od 2 do 9 puta iznad gornje granice, a prateći smernice National Kidney Foundationa jedna od indikacija za operativno lečenje je vrednost PTH iznad 800 ng/L [33]. Najviše vrednosti PTH objavio je Cabane sa saradnicima, kod njihovog pacijenta vrednost PTH iznosila je 2287 ng/L [29]. Najviša vrednost PTH našeg pacijenta iznosila je 1337 ng/L.…”