Rapid Resolution of Uremic Tumoral Calcinosis After Parathyroidectomy

Abstract

A 54-year-old man developed a progressively enlarging painless mass on both forearms with limited range of flexion following 8 years of continuous ambulatory peritoneal dialysis (Figure 1, A.). Computed tomography showed amorphous, cystic, and multilobulated calcification at the medial aspect of his elbow joints, about 6 × 4 × 9 cm in size (Figure 1, B). His serum calcium, phosphate, and intact parathyroid hormone levels were 10.5 mg/dL, 6.0 mg/dL, and 1257 pg/mL, respectively. A sonogram disclosed evidence of 4 heterogeneous hypoechoic nodules ranging from 0.7 to 2.2 cm in the bilateral retrothyroid gland region. Conservative therapy with dietary phosphate restriction, noncalcemic phosphate binders, and vitamin D did not alleviate its progression. With a diagnosis of tertiary hyperparathyroidism with tumoral calcinosis, the patient underwent parathyroidectomy, and the calcified mass disappeared within 2 months (Figure 2).