Serial explantation after parathyroid autotransplant for recurrent hypercalcemia in chronic renal failure

Development of autonomous parathyroid gland function can occur in cases of long standing renal disease, leading to hyperparathyroidism and hypercalcemia. Debate exists over the optimum surgical treatment strategy and the choice lies with the individual surgeon. We illustrated the method of total parathyroidectomy and autotransplantation to the forearm and proposed it to be superior to both total and subtotal parathyroidectomy.

This case illustrated the development of secondary and subsequently tertiary hyperparathyroidism in a 66-year-old man with a history of chronic renal failure. The patient was managed surgically by parathyroid autotransplantation and serial explantation.

Refractory hypercalcemia due to autonomous parathyroid tissue following parathyroidectomy can be managed with greater ease and efficacy by serial explantation of autotransplanted tissue versus a more difficult re-exploration of the neck.