Tertiary hyperparathyroidism as a manifestation of bone mineral metabolism disease in kidney transplant recipient: a diagnostic and therapeutic challenge. Presentation of a clinical case

  • Lourdes Balcázar-Hernández Servicio de Endocrinología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México
  • Anabel Rodríguez Manzo Servicio de Medicina Interna, Hospital General de Zona 1B, Francisco del Paso y Troncoso, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México
  • Guadalupe Vargas-Ortega Servicio de Endocrinología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México
  • Victoria Mendoza-Zubieta Servicio de Endocrinología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México
  • Baldomero González-Virla Servicio de Endocrinología, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, México
Keywords: tertiary hyperparathyroidism, kidney transplantation, hypercalcemia, parathyroidectomy

Abstract

Tertiary hyperparathyroidism (THPT) is characterized by hypercalcemia and autonomous hyperparathyroidism in the context of persistent secondary hyperparathyroidism (SHPT). THPT is related with extraskeletal calcifications, calciphylaxis, fractures, bone pain, progressive loss of bone mineral density, nephrocalcinosis, lithiasis, kidney allograft dysfunction and rejection, neuropsychiatric alterations, cardiovascular disease, and high morbimortality. Subtotal parathyroidectomy is the gold standard for treatment, with high cure rates. We described a case of THPT as a manifestation of Bone Mineral Metabolism Disease after a successful kidney transplant, with an insidious evolution and severe bone damage, with an adequate response to subtotal parathyroidectomy. We evidenced that early diagnosis and treatment of THPT in kidney transplant recipients is essential to the diminution of comorbidities, the improvement of prognosis and the optimization of health resources.

References

1) Schlosser K, Endres N, Celik I, Fendrich V, Rothmund M, Fernández ED. Surgical treatment of tertiary hyperparathyroidism: the choice of procedure matters! World J Surg. 2007;31(10):1947-53. doi: 10.1007/s00268-007-9187-z.

2) Tang JA, Friedman J, Hwang MS, Salapatas AM, Bonzelaar LB, Friedman M. Parathyroidectomy for tertiary hyperparathyroidism: A systematic review. Am J Otolaryngol. 2017;38(5):630-5. doi: 10.1016/j.amjoto.2017.06.009.

3) Shindo M, Lee JA, Lubitz CC, McCoy KL, Orloff LA, Tufano RP, et al. The Changing Landscape of Primary, Secondary, and Tertiary Hyperparathyroidism: Highlights from the American College of Surgeons Panel, "What's New for the Surgeon Caring for Patients with Hyperparathyroidism". J Am Coll Surg. 2016;222(6):1240-50. doi: 10.1016/j.jamcollsurg.2016.02.024.

4) Sharma J, Weber C. Early versus late parathyroidectomy for tertiary (posttransplant) hyperparathyroidism, p. 209-16. En: Angelos P, Grogan RH. Difficult decisions in endocrine surgery: an evidence-based approach. Springer, 2018. doi: 10.1007/978-3-319-92860-9.

5) Davies DR, Dent CE, Watson L. Tertiary hyperparathyroidism. Br Med J. 1968;3(5615):395-9. doi: 10.1136/bmj.3.5615.395.

6) Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from kidney disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006;69(11):1945-53. doi: 10.1038/sj.ki.5000414.

7) Vangala C, Pan J, Cotton RT, Ramanathan V. Mineral and bone disorders after kidney transplantation. Front Med. 2018;5:211. doi: 10.3389/fmed.2018.00211.

8) Thongprayoon C, Cheungpasitporn W. Persistent hyperparathyroidism after kidney transplantation; updates on the risk factors and its complications. J Parathyr Dis. 2018;6(1):26-8. doi: 10.15171/jpd.2018.09.

9) Balcázar-Hernández L, Vargas-Ortega G, González-Virla B, Cruz-López M, Rodríguez-Gómez R, Espinoza-Pérez R, et al. Biochemical characteristics of bone mineral metabolism before and throughout the first year after kidney transplantation, persistent hyperparathyroidism, and risk factors in a latin population. Int J Endocrinol. 2020;2020:6913506. doi: 10.1155/2020/6913506.

10) Dulfer RR, Franssen GJH, Hesselink DA, Hoorn EJ, van Eijck CHJ, van Ginhoven TM. Systematic review of surgical and medical treatment for tertiary hyperparathyroidism. Br J Surg. 2017;104(7):804-13. doi: 10.1002/bjs.1055.
Published
2021-03-25
How to Cite
1.
Balcázar-Hernández L, Rodríguez Manzo A, Vargas-Ortega G, Mendoza-Zubieta V, González-Virla B. Tertiary hyperparathyroidism as a manifestation of bone mineral metabolism disease in kidney transplant recipient: a diagnostic and therapeutic challenge. Presentation of a clinical case. Rev Nefrol Dial Traspl. [Internet]. 2021Mar.25 [cited 2024Jul.16];41(1):72-8. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/620
Issue
Vol. 41 No. 1 (2121): Jan.-March
Section
Images in Nephrology

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