Spontaneous remission of recurrent secondary hyperparathyroidism

The Case | Severe acute hypocalcemia in a patient on hemodialysis

“…Parathyroid gland spontaneous necrosis, also known as parathyroid apoplexy, is defined by infarction or hemorrhage or both within a parathyroid adenoma. [1][2][3] It is considered secondary to an imbalance between the growth of the adenoma and its blood supply, suggesting that large adenomas are more susceptible to ischemic insult. 1,3 Parathyroid apoplexy has mostly been documented in cases of spontaneous remission of primary hyperparathyroidism (w100 case reports).…”

“…1 In contrast, it has been reported very rarely in patients with secondary hyperparathyroidism. 2,3 Clinical and biological presentation mimics the hungry bone disease that can be observed after surgical parathyroidectomy, with a sudden drop of PTH and calcium levels and a rise of alkaline phosphatase levels. 2,3 Most reported cases presented with acute symptoms of hypocalcemia.…”

“…2,3 Clinical and biological presentation mimics the hungry bone disease that can be observed after surgical parathyroidectomy, with a sudden drop of PTH and calcium levels and a rise of alkaline phosphatase levels. 2,3 Most reported cases presented with acute symptoms of hypocalcemia. Rarely, hemorrhage may extend to extracapsular space and cause symptoms ranging from local pain to airway compromise.…”

“…As parathyroid apoplexy is an uncommon complication, its management is not well established. 2,3 Urgent treatment of severe hypocalcemia is warranted: high-dose calcium supplementation, daily hemodialysis with dialysate rich in calcium, and high doses of calcitriol.…”