NDT Advance Access originally published online on September 5, 2008
Nephrology Dialysis Transplantation 2008 23(12):4073-4074; doi:10.1093/ndt/gfn391
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Spontaneous remission of hyperparathyroidism
Nephrol Dial Transplant 2008; doi:10.1093/ndt/gfn397E-mail: drasko.pavlovic{at}bol-svduh.t-com.hr
Sir,
We read with great interest the case report concerning spontaneous remission of severe hyperparathyroidism published by our Japanese colleagues [1].
We wish to underscore two things from their report.
Firstly, 17 years ago we presented a chronic kidney disease patient with spontaneous inflammation remission of a parathyroid tumour. By fine-needle aspiration biopsy, an inflammatory process was proven [2]. In the next 5 years, three more patients with similar clinical symptoms were observed [3]. In two of them, inflammatory changes of parathyroid glands were proven by cytology, and in one, after surgery, a haemorrhage with subsequent fibrosis and spontaneous sclerosis of the parathyroid gland was proven. Remission of hyperparathyroidism was not observed due to the enlargement of the other parathyroid glands. In all of the patients, before spontaneous pathological changes, an enlarged volume of the parathyroid gland was detected by ultrasound, from 3.92 cm3 to 32.5 cm3. In our patients, secondary hyperparathyroidism due to nodular parathyroid gland hyperplasia was considered, and in a case described by Komaba et al., primary adenoma was considered. Spontaneous changes of the parathyroid gland were due to autoinfarction in the Japanese case. Regardless of the pathological changes, it appears that enlarged parathyroid glands, i.e. adenoma or nodular hyperplasia, are susceptible to autoinfarction, necrosis and haemorrhage of even spontaneous inflammation. As we have concluded previously, our knowledge of parathyroid pathology is insufficient at this time [3].
Secondly, in our patients we were not able to use a new third-generation PTH assay. From the report of Komaba and his colleagues, as well from some others, it appears that a new assay could be a marker of more severe hyperparathyroidism [4]. We agree with the statement that we need more data to elucidate the relationship between the third-generation PTH assay and the severity of secondary hyperparathyroidism. In our view, parathyroid sonography and the new PTH assay could be useful in an evaluation of the severity of hyperparathyroidism. Unfortunately, in our opinion parathyroid sonography as an inexpensive and non-invasive method still does not have a significant place in the daily work of many hospitals [5].
Conflict of interest statement. None declared.
1 Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital, Vinogardska c.29 2 Department of Nuclear Medicine Zagreb University Hospital, Zagreb Croatia
References
- Komaba H, Takeda Y, Abe T, et al. Spontaneous remission of severe hyperparathyroidism with normalization of the reversed whole PTH/intact PTH ratio in a haemodialysis patients. Nephrol Dial Transplant (2008) 23:1760–1762.
[Free Full Text] - Tomic Brzac H, Pavlovic D, Crepinko I. Spontaneous inflamation-induced remission of parathyroid tumour in secondary hyperparathyroidism. Nephrol Dial Transplant (1991) 6:134–138.
[Free Full Text] - Pavlovic D, Tomic Brzac H. Unusual changes in parathyroid glands in patients with chronic renal failure. J Clin Endocrinol Metab (1997) 82:703–705.
[Free Full Text] - Arakawa T, D’Amour P, Rousseau L, et al. Overproduction and secretion of a novel amino-terminal form of parathyroid hormone from a severe type of parathyroid hyperplasia in uremia. Clin J Am Soc Nephrol (2006) 1:525–531.
[Abstract/Free Full Text] - Pavlovic D, Tomic Brzac H. Ultrasonographic evaluation of parathyroid hyperplasia in dialysis patients. Sci World J (2006) 6:1599–1608. DOI 10.1100/tsw.2006.273.
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