Parathyroidectomy for Parathyroid Carcinoma in Renal Transplantation

Obregón, Liliana; Taylor, Marcelo F; Mir, German; Pereyra, C.A.; Pianzola, Horacio M; Petrone, H.; Barán, Marcelo; Menna, M.

doi:10.1016/j.transproceed.2004.12.305

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…Bone disease following renal transplantation remains a formidable problem with a complex etiology related to steroid therapy, calcineurin inhibitor therapy, phosphate losses and persistent HPT (4,20–23). Persistent HPT primarily due to diffuse parathyroid hyperplasia is well recognized as an important and common mediator of bone loss following renal transplantation (24–26). In the setting of normal to low calcium and diminished phosphate levels, therapies such as exogenous vitamin D and calcium supplements act to suppress PTH secretion (27).…”

Section: Discussionmentioning

confidence: 99%

Early and Severe Hyperparathyroidism Associated with Hypercalcemia After Renal Transplant Treated with Cinacalcet

Leca

Laftavi

Gundroo

et al. 2006

American Journal of Transplantation

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Bone disease is a common clinical problem following renal transplantation. In renal transplant recipients, multiple underlying factors determine the extent of bone loss and the subsequent risk of fractures. In addition to the well-recognized risk to bone disease posed by steroids, calcineurin inhibitors and preexisting bone disease, persistent hyperparathyroidism (HPT) contributes to post-transplant bone loss. HPT is usually treated with vitamin D supplements combined with calcium. Patients whose HPT is associated with hypercalcemia pose a difficult therapeutic dilemma which often requires parathyroidectomy. Cinacalcet, a calcium mimetic agent, offers a unique pharmacologic approach to the treatment of patients with posttransplant hypercalcemia and HPT. In this paper, we describe the clinical course and biochemical changes in 10 renal transplant recipients with hypercalcemia and severe HPT early after renal transplantation treated with cinacalcet. Cinacalcet therapy corrected hypercalcemia and decreased parathyroid hormone (PTH) levels in all cases. A transient rise in the level of alkaline phosphatase was noted following initiation of cinacalcet therapy. In this patient population, correction of HPT was not permanent as discontinuing cinacalcet therapy led to a rapid rise in PTH level.

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Section: Discussionmentioning

confidence: 99%

Early and Severe Hyperparathyroidism Associated with Hypercalcemia After Renal Transplant Treated with Cinacalcet

Leca

Laftavi

Gundroo

et al. 2006

American Journal of Transplantation

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“…[49][50][51][52] This is a rare autosomal dominant familial cancer syndrome manifested by primary hyperparathyroidism, ossifying tumours of the maxilla and mandible, parathyroid proliferations and, less commonly, uterine neoplasms, renal cysts, hamartomas and Wilms' tumours. [61][62][63] LUNG Pulmonary neuroendocrine tumours (NETs) are a distinct subset of neoplasms, ranging from low grade 'typical carcinoid' tumours to intermediate grade 'atypical carcinoid' tumours to high grade small cell and large cell neuroendocrine carcinomas. Importantly, somatic HRPT2 mutations are also found in approximately 70% of sporadic parathyroid carcinomas, 51,52 and loss of parafibromin is regarded as a diagnostic marker for parathyroid carcinomas; 59,60 however, the sporadic lesions are usually not associated with underlying hyperplasia.…”

Section: Parathyroidmentioning

confidence: 99%

Precursor lesions of endocrine system neoplasms

Mete

Sylvia

2013

Pathology

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“…It has also been suggested that in this patients, the levels of Hypercalcemia are relatively smaller in comparison of those of PTH. 3 Furthermore, the role of parafibromin in this subgroup of patients might not be so clear; in a study on metastatic PTC in CKD, Tominaga Y et al, 16 found positive staining for parafibromin in 7 of 8 examined glands.…”

Section: Introductionmentioning

confidence: 98%

“…1,2 Despite the high frequency of secondary hyperparathyroidism in chronic kidney disease (CKD) patients, PTC is extremely rare, with less than 30 cases reported in the literature. [3][4][5] The diagnosis of PTC is difficult. Usually presents symptoms and signs of Hypercalcemia: fatigue, weight loss, anorexia, nausea, vomiting, polyuria and polydipsia; besides, the patient can present nephrolithiasis, bone pain and fractures.…”

Section: Introductionmentioning

confidence: 99%

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

Cabané¹,

Gac²,

Alvo³

et al. 2016

EMIJ

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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.

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Parathyroidectomy for Parathyroid Carcinoma in Renal Transplantation

Cited by 7 publications

References 8 publications

Early and Severe Hyperparathyroidism Associated with Hypercalcemia After Renal Transplant Treated with Cinacalcet

Early and Severe Hyperparathyroidism Associated with Hypercalcemia After Renal Transplant Treated with Cinacalcet

Precursor lesions of endocrine system neoplasms

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

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