A Case Report: Recurrent Hyperparathyroidism After Parathyroidectomy in a Primary Hyperparathyroidism Patient with Chronic Kidney Disease

Abstract

Background: Parathyroidectomy (PTX) is the definitive treatment of primary hyperparathyroidism (PHPT) for symptomatic patients. PTX for hyperparathyroidism is associated with the risk of recurrence; however, this has been mostly demonstrated in chronic kidney disease (CKD) patients with secondary hyperparathyroidism. The recurrent risk of hyperparathyroidism and renal outcomes after PTX in patients with PHPT has been rarely reported. Patient: In this article, we report a case of a 70-year-old man with previously diagnosed CKD, underwent a subtotal PTX for asymptomatic primary hyperparathyroidism induced by parathyroid hyperplasias. The PTX appears to resolve the calcium disturbance in this patient. However, at three months after the surgery, the diagnosis of recurrent hyperparathyroidism was made, based on a remarkably increased level of parathyroid hormone from 42.12 pg/ml to 270.9 pg/ml. Over 2 years of follow-up, his renal function, as evaluated by serum creatinine levels, fluctuated modestly, but persist at a preoperative level of renal impairment. These data indicate that this patient with asymptomatic PHPT has experienced recurrent hyperparathyroidism with persistent renal dysfunction after PTX. Conclusion: The recurrent hyperparathyroidism after PTX in PHPT patients with a coexisting renal impairment appears more common than might be anticipated. We recommend that if hyperparathyroidism recurs or exacerbates by the persistent renal dysfunction after PTX, the potential benefits of PTX should be reconsidered and carefully weighed against the possible surgical risks.