Spontaneous Remission of Severe Hyperparathyroidism in Chronic Renal Failure

Abstract

The sudden onset of hypocalcemia occurring in a patient undergoing hemodialysis led to the diagnosis of spontaneous remission of severe hyperparathyroidism. This was confirmed by a marked reduction in immunoreactive parathyroid hormone level. The hypocalcemia was controlled by 1,25-dihydroxycholecalciferol. A dramatic improvement of hyperparathyroid bone disease, as assessed by radiographic and histomorphometric examination, was observed.

Spontaneous Remission of Severe Hyperparathyroidism in Chronic Renal Failure

“…Rapid onset of hypocalcémie symptoms and signs, and cervical pain in a dialyzed patient with severe bone disease are the distinctive clinical features in our patient and in two previous reports [1,4], In our case, spontaneous hemor rhagic necrosis of a large parathyroid gland, with the sudden loss of at least 60% of all parathyroid tissue, was shown to be the definite cause of this clinical picture. The other three parathyroid glands were shown to be hyperplastic, as was possibly the case in the patients described by Ahmad et al [4] and Charhon et al [1], since PTH levels in these patients were still high when hypocalcemia was detected, although to a much lower level than before the event.…”

“…The other three parathyroid glands were shown to be hyperplastic, as was possibly the case in the patients described by Ahmad et al [4] and Charhon et al [1], since PTH levels in these patients were still high when hypocalcemia was detected, although to a much lower level than before the event.…”

“…Necrosis of a large parathyroid gland (a wellrecognized, though unusual, event in primary hyperpara thyroidism due to a single parathyroid adenoma) [2,3], was correctly supposed to be the most likely explanation for the sudden hypocalcemia in the patient described, even though all parathyroid glands are usually hyperplastic in chronic renal failure. Unfortunately, Charhon et al [1] were unable to give a pathologic confirmation of their suggestion; the authors [4] of a second recent report of a very similar case could not do so either.…”

“…We were interested to read the paper by Charhon et al [1] concerninga case of spontaneous resolution of severehyperparathyroidism in a patient on a long-standing dialytic treatment. Necrosis of a large parathyroid gland (a wellrecognized, though unusual, event in primary hyperpara thyroidism due to a single parathyroid adenoma) [2,3], was correctly supposed to be the most likely explanation for the sudden hypocalcemia in the patient described, even though all parathyroid glands are usually hyperplastic in chronic renal failure.…”

Spontaneous remission of primary hyperparathyroidism: A case report and meta-analysis of the literature

“…Kovacs and Gay summarize 12 (including their case report) documented cases of autoinfarction of a parathyroid adenoma according to such parameters as total calcium, signs, symptoms, and other patient characteristics such as age and sex and mass size at resection, autopsy, or ultrasonography 6, 9–17. PTH concentration was not a parameter in their summary, and cases of multiple adenomas, hyperplasia, and cysts were also omitted.…”