Stehman-Breen C, Muirhead N, Thorning D, Sherrard D
Secondary hyperparathyroidism complicated by
Am J Kidney Dis
(Oct) 28:502-507 1996
The authors present 5 cases of parathyromatosis and discuss the
difficulties encountered in their management. Parathyromatosis is the
condition when multiple nodules or rests of parathyroid tissue
hyperfunction resulting in refractory hyperparathyroidism. The cause
is usually the result of seeding of parathyroid tissue following
surgical manipulation of the parathyroid glands and can occur locally,
within the neck or mediastinum, or distally, at the site of
parathyroid implantation, usually the arm. The development of
parathyromatosis may be explained by the recent observation that
hyperplastic parathyroid tissue may undergo monoclonal transformation
into adenomas as discussed by the authors.
All 5 cases were patients who had very severe hyperparathyroidism
requiring multiple surgical interventions. Although, these patients
presented prior to the routine use of calcitriol and calcium for the
medical control of hyperparathyroidism, parathyroidectomy is still
required in a subset of patients with refractory hyperparathyroidism.
These cases exemplify both the controversy and difficulty associated
with the surgical management of refractory hyperparathyroidism. The
appropriate surgical procedure which should be preformed is unclear.
As suggested by the authors, we also prefer a subtotal
parathyroidectomy in which the three largest glands are removed and
the smallest gland is left intact.
Comment: In summary, these cases illustrate the malignant
nature of hyperparathyroidism and that it is not a disease curable by
surgery. This manuscript underscores the importance of identifying
and medically treating patients prior to the need for surgical
intervention. (Stuart Sprague, M.D., Northwestern University,