Development of parathyroid adenoma in a case of chronic renal failure suggesting tertiary hyperparathyroidism

A case of tertiary hyperparathyroidism with a parathyroid adenoma and hyperplasia was described as the first report in Japan. A 24-year-old man manifesting hypercalcemia had been treated with hemodialysis for 9 years. On admission, clubbed fingers richitic rosaries and a palpable node in the neck were the major physical findings. Laboratory examinations revealed hypercalcemia had elevated levels of plasma parathyroid hormone (PTH) in a c-terminal assay. Nevertheless the levels of PTH found by a n-terminal assay disclosed an only small increase. The PTH levels were scarcely decreased after a bolus injection of calcium gluconate. A large tumor corresponding to the palpable node was resected. Histologically, the tumor was an adenoma with thick fibrous capsule and interparenchymal bands. Other parathyroid glands showed secondary clear cell hyperplasia without signs of cellular hyperactivity.