Abstract
Background
Parathyromatosis is defined as multiple foci of benign hyperfunctioning parathyroid tissue in the neck or mediastinum. Parathyromatosis is a problematic cause of recurrent hyperparathyroidism (HPT). In renal HPT, the stimuli of the parathyroid cells persist after parathyroidectomy (PTx), and for this reason, parathyromatosis might be important in renal HPT.
Methods
Between July 1973 and December 2005, 1,932 patients underwent PTx for advanced renal HPT in our department. We evaluated the frequency, clinical findings and the prognosis of this kind of parathyroid disorder.
Results
After total PTx with forearm autograft for renal HPT, which was performed initially in our department, the risk for developing parathyromatosis was 0.11% (2/1837); after sub-total PTx, it was 5% (1/20). The risk for developing parathyromatosis was lower after total PTx with forearm autograft than after sub-total PTx (P < 0.05). In patients who developed persistent or recurrent HPT and were referred to our department for neck re-operation, parathyromatosis occurred in 12.1% (7/58); in those originally operated on at our hospital, the corresponding figure was 7.1% (3/42). This difference was not significant (P = 0.42). Only in 4 of 10 patients was parathyromatosis suggested before re-operation. However, in spite of several re-operations, high parathyroid hormone (PTH) levels persisted in 6 of 10 patients with parathyromatosis.
Conclusion
Parathyromatosis is a non-negligible cause of recurrent renal HPT in patients who require neck re-exploration. Parathyromatosis is difficult to diagnose pre-operatively and completely controlled by re-operation. Parathyromatosis should be kept in mind when performing neck re-exploration for recurrent renal HPT.
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References
Aeddick RL, Ccsta JO, Marx SJ. Parathyroid hyperplasia and parathyromatosis. Lancet. 1977;1:549
Lee PC, Mateo RB, Clarke MR, et al. Parathyromatosis: a case for recurrent hyperparathyroidism. Endocr Pract 2001;7:89–92
Stehman-Breen C, Muirhead N, Thorning D, et al. Secondary hyperparathyroidism complicated by parathyromatosis. Am J Kidney Dis 1996;28:502–507
Tominaga Y, Katayama A, Sato T, et al. Re-operation is frequently required when parathyroid glands remain after initial parathyroidectomy for advanced secondary hyperparathyroidism in uraemic patients. Nephrol Dial Transpl 2003;18(Suppl 3):65–70
Tominaga Y, Uchida K, Haba T, et al. More than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism. Am J Kidney Dis 2000;1(Suppl):S168–S171
Hibi Y, Tominaga Y, Uchida K, et al. Cases with fewer than four parathyroid glands in patients with renal hyperparathyroidism at initial parathyroidectomy. World J Surg 2002;26:314–317
Matsuoka S, Tominaga Y, Uno N, et al. Calciphylaxis: a rare complication of patients who required parathyroidectomy for advanced renal hyperparathyroidism. World J Surg 2005;29:632–635
Tominaga Y. Surgical management of secondary hyperparathyroidism in uremia. Am J Med Sci 1999;317:390–397
Tominaga Y, Numano M, Tanaka Y, et al. Surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 1997;13:87–96
Matsuoka S, Tominaga Y, Uno N, et al. Surgical significance of undescended parathyroid gland in renal hyperparathyroidism. Surgery 2006;139:815–820
Tominaga Y. Management of renal hyperparathyroidism. Biomed Pharmacother 2000;54(Suppl1):25–31
Cho FF, Lee CH, Chen HY, et al. Persistent and recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation. Ann Surg 2002;235:99–104
Li ML, Fitzgerald PA, Price DC, et al. Iatrogenic pheochromocytomatosis: a previously unreported result of laparoscopic adrenalectomy. Surgery 2001;130:1072–1077
Sivula A. Recurrence of benign phaeochromocytoma by intraoperative implantation. Acta Chir Scand 1974;140:334–339
Palmer JA, Brown WA, Kerr WH, et al. The surgical aspects of hyperparathyroidism. Arch Surg 1975;110:1004–1007
Reddick RL, Costa JC, Marx SJ. Parathyroid hyperplasia and parathyromatosis. Lancet 1977;5:549
Fitko R, Roth Sl, Hines JR, et al. Parathyromatosis in hyperparathyroidism. Hum Pathol 1990;21:234–237
Fraker DL, Travis WD, Merendino JJ Jr, et al. Locally recurrent parathyroid neoplasms as a cause for recurrent and persistent primary hyperparathyroidism. Ann Surg 1991;213:58–65
Akerstrom G, Rudberg C, Grimelius L, et al. Recurrent hyperparathyroidism due to peroperative seeding of neoplastic or hyperplastic parathyroid tissue. Acta Chir Scand 1988;154:549–552.
Kollmorgan CF, Aust MR, Ferreiro JA, et al. Parathyromatosis: a rare yet important cause of persistent or recurrent hyperparathyroidism. Surgery 1994;116:111–115
Kessler M, Avila JM, Renoult E, et al. Reoperation for secondary hyperparathyroidism in chronic renal failure. Nephrol Dial Transpl 1991;6:176–179
Falvo L, Catania A, Sorrenti S, et al. Relapsing secondary hyperparathyroidism due to multiple nodular formations after total parathyroidectomy with autograft. Am Surg 2003;69:998–1002
Rattner DW. Marrone GC, Kasdon E, et al. Recurrent hyperparathyroidism due to implantation of parathyroid tissue. Am J Surg 1985;149:745–748
Neumann DR, Esselstyn CB Jr, Madera AM. Sestamibi/iodine subtraction single photon emission computed tomography in reoperative secondary hyperparathyroidism. Surgery 2000;128:22–28
Baloch ZW, Fraker D, LiVolsi VA. Parathyromatosis as cause of recurrent secondary hyperparathyroidism: a cytologic diagnosis. Diagn Cytopathol 2001;25:403–405
Acknowledgements
We thank Professor Henry Johansson, Department of Surgery, Uppsala University Hospital, for his kind advice and valuable discussions.
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Matsuoka, S., Tominaga, Y., Sato, T. et al. Recurrent Renal Hyperparathyroidism Caused by Parathyromatosis. World J. Surg. 31, 299–305 (2007). https://doi.org/10.1007/s00268-006-0391-z
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DOI: https://doi.org/10.1007/s00268-006-0391-z