Parathyroid Adenoma after Kidney Transplantation: A case report

Choi, Eun Chang; Chung, Ku Yong; Kang, Duk Hee; Choi, Keum Ja; Yoon, Kyun Il; Choi, Yong Man

Abstract

In Uremic condition, Secondary Hyperparathyroidism ensues due to phosphate retention, low level of calcitriol, decreased calcium absorption from intestine, skeletal resistance to the Parathyroid Hormone (PTH), hypocalcemia and eventually parathyroid hyperplasia. Theoretically, Reversal of hyperparathyroidism can be expected after successful kidney transplantation. However, Some patients show continuous increase of parathyroid function due to autonomous excretion of PTH, in which case, we could assume a tertiary hyperparathyroidism. There were sporadic reports for the treatment of tertiary hyperparathyroidism after successful kidney transplantation. And in some aspects, there remains a controvesrsy about the timing of parathyroidectomy. The occurrence of a single parathyroid adenoma after kidney transplantation is ever unusual finding. In our hospital, we have experienced a case of parathyroid adenoma who had taken successful kidney transplantation. The patient was 62 year old man who had a long duration of hemodialysis for 10 years. His hypercalcemic findings were managed medically for 1 year. As the patient's hypercalcemic symptom aggrevated, he was admitted and parathyroid adenoma was diagnosed by a CT scan and parathyroid scan. After excsion of the parathyroid adenoma, his general condition and kidney function improved. In our conclusion, there may be a debate for the timing of subtotal parathyroidectomy in the patient with tertiary hyperparathyroidism after kidney transplantation. But when the patient shows a hypercalcemic profile, the parathyroid scan, CT scan, Neck Ultrasonography must be considered to detect single parathyroid adenoma which is so simple to remove surgically.