Parathyroidectomy for tertiary hyperparathyroidism after second kidney transplantation: a case report

Area of Science:

• Nephrology
• Endocrinology
• Surgical Oncology

Background:

• Secondary hyperparathyroidism (SHPT) often resolves post-kidney transplant, but persistent cases may indicate tertiary hyperparathyroidism (THPT).
• The optimal timing for parathyroidectomy (PTX) in post-transplant THPT remains debated.
• This case highlights the management of prolonged hypercalcemia due to THPT in a kidney transplant recipient.

Observation:

• A 58-year-old woman with a history of kidney transplantation experienced persistent hyperparathyroidism.
• Despite dialysis and medication, serum intact parathyroid hormone (iPTH) levels remained significantly elevated.
• Imaging confirmed THPT, leading to PTX 14 months after a second kidney transplant.

Findings:

• Histological examination revealed nodular hyperplasia of all parathyroid glands, indicating autonomous hormone secretion.
• The patient's case highlights the challenges in managing persistent THPT post-kidney transplantation.
• Severe SHPT prior to transplantation may predict the development of THPT.

Implications:

• Consider earlier surgical referral for parathyroidectomy in patients with severe SHPT before kidney transplantation.
• Individual risk factors should guide the decision for PTX timing in post-transplant hyperparathyroidism.
• This case underscores the need for a clear surgical consensus on managing THPT.