이차성부갑상선기능항진증이 있는 복막투석환자에게 시행한 복강 내 Paricalcitol 투여 치료 1예

전지민 ( Ji Min Jeon ),박용기 ( Yong Ki Park ),오준석 ( Joon Suk Oh ),김성민 ( Sung Min Kim ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.2

Secondary hyperparathyroidism is a major complication in ESRD patients undergoing dialysis. In hemodialysis patients with secondary hyperparathyroidism, intravenous administration of paricalcitol became widely utilized. In CAPD patients, however, the intravenous administration of paricalcitol which requires frequent visits to the clinic is not practical. The subject of this study was one CAPD patient with secondary hyperparathyroidism. He had already received oral calcitriol pulse therapy for 6 months and thereafter refused parathyroidectomy and intravenous paricalcitol which required frequent visits to the hospital. Furthermore, paricalcitol capsule is not yet introduced in Korea. Consequently, intraperitoneal paricalcitol therapy was tried whereby the patient was taught how to inject the paricalcitol (5 ug) directly into the dialysate for three times per week before bedtime. Blood samples for measurement of intact parathyroid hormone (iPTH), serum ionized calcium, serum phosphate, serum total alkaline phosphatase levels were obtained at baseline and after 1, 2, 3 and 4 months of treatment. After usage of intraperitoneal paricalcitol for 2 months, there was a significant decrease in iPTH level. In conclusion, intraperitoneal paricalcitol therapy might be effective for suppressing iPTH in CAPD patients with secondary hyperparathyroidism. A large-scale and long-term study must be conducted for safety and clinical effect.

속발성 부갑상선 기능항진증의 수술적 치료경험 2예

홍석준,박수길,공병엽 울산대학교 의과대학 1995 울산의대학술지 Vol.4 No.2

Secondary hyperparathyroidism is the condition is which increased parathyroid hormone(PTH) is secreted to compensate for a chronically low calcium level and chronic renal failure is the most common cause. In 1934, Albreight reported an assocition between hyperparathyroidism and the chronic renal failure and in 1960, stanbury first reported subtotal parathyroidectomy in the treatment of secondary hyperparathyroidism. The physiologic mechanisms leading to secondary hyperparathyroidism in the chronic renal failure are well known and relatively well controled with medical management, but sometimes may necessitate surgical intervention in medically intractable cases. In Korea, the surgery of secondry hyperparathyroidism is not frequently done yet as in western countries. We experienced two cases of secondary hyperparathyroidism recently and report its results of subtotal parathyroidectomy.

이차성 부갑상선항진증의 부갑상선절제술 시Methylene Blue 주입술의 유용성

차원재,하정훈,장동엽,정영호,정은정,성명훈,김광현 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.1

Background and Objectives:The localization of parathyroid The purpose of this study was to introduce the intraoperative methylene blue infusion as a localization modality of parathyroid glands and to determine the usefulnes of intraoperative methylene blue infusion for localization of parathyroid glands in secondary hyperparathyroidism. Materials and Method:Seven prospective cases of secondary hyperparathyroidism surgicaly treated from Sep. 2004 to Mar. 2006 were included in this study. In parathyroidectomy, intraoperative methylene blue infusion for localization of parathyroid glands was performed. Results:In six cases of initial operation, four parathyroid glands were well stained and in a case of reoperation, thre parathyroid glands were stained. After the surgery, all patients were well controlled in symptoms and calcium levels in blood serum, and 6 patients reached normal iPTH levels in serum. Conclusion:Intraoperative methylene blue infusion is an efective localization tool in parathyroidectomy for secondary hyperparathyroidism. (Korean J Otolaryngol 2007 ;50 :64-9)

이차성 부갑상선기능항진증에서 부갑상선전절제술 및 자가 이식술 1례

김성훈,서다혜,황선덕,김지원 대한갑상선학회 2019 International Journal of Thyroidology Vol.12 No.1

Secondary hyperparathyroidism (HPT) usually result from parathyroid gland hyperplasia that produces excess parathyroid hormone (PTH). Decreased renal function leads to elevate serum phosphate levels and reduce vitamin D production, which results in hypocalcemia. Skeletal resistance to PTH results in persistently and frequently extremely elevated PTH levels and renal osteopathy. Treatment of choice for secondary HPT is medical management including calcitriol and vitamin D. However, for some cases in calciphylaxis and the failure including PTH >800 pg/mL or osteoporosis under maximal medical management surgical intervention could be an alternative option. We described a case of 47-year-old woman with surgical intervention for secondary hyperparathyroidism.

Secondary hyperparathyroidism due to multiple parathyroid carcinomas in a patient with chronic hemodialysis: a case report

Ryang So Ree,이욱,김미진,송상헌,이병주,김보현 고신대학교(의대) 고신대학교 의과대학 학술지 2022 고신대학교 의과대학 학술지 Vol.37 No.3

Parathyroid carcinoma (PC) in cases of secondary or tertiary hyperparathyroidism is relatively uncommon, and only a few case reports have described this entity. Although some papers have reported patients with one or two parathyroid malignancies, multiple PC–especially three or more–have been even more rarely reported. Herein, we report a case of secondary hyperparathyroidism due to multiple PCs in a chronic hemodialysis patient. A 54-year-old man with end-stage kidney disease was referred for hyperparathyroidism. He had been diagnosed with chronic kidney disease in 2001 and had begun hemodialysis in 2009. In laboratory tests, intact parathyroid hormone (iPTH) was markedly elevated to 1,144.1 pg/mL (normal range: 15.0–68.3 pg/mL) and serum calcium was mildly elevated to 10.56 mg/dL (normal range: 8.5–10.3 mg/dL). Ultrasonography showed hypoechoic nodules in the posterior part of both thyroid glands. All three nodules showed increased uptake on a 99mTc sestamibi scan. The patient underwent total parathyroidectomy with autotransplantation to the right forearm. Histopathology findings showed three PCs with capsular invasion and one parathyroid hyperplasia. In the immediate postoperative period, the iPTH level dropped from 1,446.8 to 82.4 pg/dL and, after 1 month, to 4.0 pg/dL. This patient needed oral calcium carbonate and active vitamin D to maintain appropriate serum calcium levels. Although multiple PCs are rare, they can cause secondary hyperparathyroidism. Therefore, clinicians should suspect multiple PCs when patients’ serum iPTH levels are exceptionally high. Additionally, since PCs could occur in multiple glands, autotransplantation of the parathyroid gland after parathyroidectomy should be done carefully.

Predictors of early postoperative hypocalcemia after total parathyroidectomy in renal hyperparathyroidism

Poh Guan Tan,Imi Sairi Ab. Hadi,Zalina Zahari,Maya Mazuwin Yahya,Wan Zainira Wan Zain,Michael Pak-Kai Wong,Rosnelifaizur Ramely,Mohd Nizam Md Hashim,Syed Hassan Syed Abd. Aziz,Zaidi Zakaria,Andee Dzul 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.98 No.1

Purpose: Patients with secondary hyperparathyroidism are at high risk for developing postoperative hypocalcemia. However, there are limited data regarding predictors of postoperative hypocalcemia in renal failure patient with secondary hyperparathyroidism. This study aimed to determine the clinical presentations of renal hyperparathyroidism and the predictors of early postoperative hypocalcemia after total parathyroidectomy. Methods: Data of patients with renal hyperparathyroidism who underwent total parathyroidectomy between January 2007 to December 2014 were reviewed retrospectively. Patients were divided into 2 cohort groups according to their serum calcium levels within 24 hours of parathyroidectomy: the hypocalcemia group (calcium levels of 2 mmol/L or less), and the normocalcemia group (calcium levels more than 2 mmol/L). With the use of multivariable logistic regression analyses, the predictors of early postoperative hypocalcemia after total parathyroidectomy in patients with renal hyperparathyroidism were investigated. Results: Among 68 patients, 56 patients (82.4%) were symptomatic preoperatively. Fifty patients (73.5%) presented with bone pain and 14 patients (20.6%) had muscle weakness. Early postoperative hypocalcemia occurred in 25 patients (36.8%). Preoperative alkaline phosphatase level was the predictor of early postoperative hypocalcemia (adjusted odds ratio, 1.004; 95% confidence interval, 1.001–1.006; P = 0.002). Conclusion: Results from our study show that most of the patients with renal hyperparathyroidism were symptomatic preoperatively and the most common clinical presentations were bone pain and muscle weakness. The significant predictor of early postoperative hypocalcemia after total parathyroidectomy was the preoperative alkaline phosphatase levels.

A case of mucolipidosis II presenting with prenatal skeletal dysplasia and severe secondary hyperparathyroidism at birth

Heo, Ju Sun,Choi, Ka Young,Sohn, Se Hyoung,Kim, Curie,Kim, Yoon Joo,Shin, Seung Han,Lee, Jae Myung,Lee, Juyoung,Sohn, Jin A,Lim, Byung Chan,Lee, Jin A,Choi, Chang Won,Kim, Ee-Kyung,Kim, Han-Suk,Kim, B The Korean Pediatric Society 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.11

Mucolipidosis II (ML II) or inclusion cell disease (I-cell disease) is a rarely occurring autosomal recessive lysosomal enzyme-targeting disease. This disease is usually found to occur in individuals aged between 6 and 12 months, with a clinical phenotype resembling that of Hurler syndrome and radiological findings resembling those of dysostosis multiplex. However, we encountered a rare case of an infant with ML II who presented with prenatal skeletal dysplasia and typical clinical features of severe secondary hyperparathyroidism at birth. A female infant was born at $37^{+1}$ weeks of gestation with a birth weight of 1,690 g (<3rd percentile). Prenatal ultrasonographic findings revealed intrauterine growth retardation and skeletal dysplasia. At birth, the patient had characteristic features of ML II, and skeletal radiographs revealed dysostosis multiplex, similar to rickets. In addition, the patient had high levels of alkaline phosphatase and parathyroid hormone, consistent with severe secondary neonatal hyperparathyroidism. The activities of ${\beta}$-D-hexosaminidase and ${\alpha}$-N-acetylglucosaminidase were moderately decreased in the leukocytes but were 5- to 10-fold higher in the plasma. Examination of a placental biopsy specimen showed foamy vacuolar changes in trophoblasts and syncytiotrophoblasts. The diagnosis of ML II was confirmed via GNPTAB genetic testing, which revealed compound heterozygosity of c.3091C>T (p.Arg1031X) and c.3456_3459dupCAAC (p.Ile1154GlnfsX3), the latter being a novel mutation. The infant was treated with vitamin D supplements but expired because of asphyxia at the age of 2 months.

이차성 부갑상선 기능항진증과 연관되어 발생한 상악골의 갈색종 1예

박동욱,이찬구,이재용,김희경 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.4

Brown tumors are focal bone lesions caused by increased osteoclastic activity and fibroblastic proliferation encountered in primary, or more rarely, secondary hyperparathyroidism. Ninety-two percent of the patients who undergo dialysis develop secondary hyperparathyroidism. Of these, approximately 1.5% develops brown tumors. We recently experienced a case of brown tumor of the left maxilla that occurred in association with secondary hyperparathyroidism in a 56-year-old female. We present the clinical characteristics, radiological and pathological findings, and treatment of this rare disease entity with a literature review.

만성 콩팥병에 의한 이차성 부갑상선 기능 항진증에서 부갑상선 아전절제술의 유용성: 장기 추적 결과

박창호,지용배,송창면,이창화,김근호,태경 대한이비인후과학회 2013 대한이비인후과학회지 두경부외과학 Vol.56 No.3

Background and Objectives Most secondary hyperparathyroidism is caused by chronic kidney disease. The purpose of this study is to evaluate the effectiveness of subtotal parathyroidectomy in the surgical treatment of renal hyperparathyroidism. Subjects and Method We studied twelve patients with renal hyperparathyroidism who underwent parathyroidectomy from Dec. 2002 to Mar. 2007. We measured the amount of serum, intact parathyroid hormone, calcium, ionized calcium, inorganic phosphorus, and alkaline phosphatase preoperatively and postoperatively. Results Subtotal parathyroidectomy was performed in nine patients, and three enlarged parathyroid glands were removed from three patients. Hyperparathyroidism was observed in four patients (33.3%), normal parathyroid function in six patients (50.0%) and hypoparathyroidism in two patients (16.7%) at 5 years after surgery. All of three patients who had removed three enlarged parathyroid glands showed persistent hyperparathyroidism. Serum ionized calcium was normal in 10 patients and two patients showed hypocalcemia after operation. Conclusion Based on the results of this study, we conclude that subtotal parathyroidectomy may be effective in the surgical treatment of renal hyperparathyroidism. However, further studies are necessary to determine the optimal amount of remnant parathyroid tissue in subtotal parathyroidectomy to maintain normal parathyroid function postoperatively.

술 중 부갑상선 호르몬 측정을 이용해 제거한 초과수 2차성 부갑상선 기능 항진증 1예

한동열,김진국,이용화,이승원 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.3

The incidence of hyperparathyroidism has slowly increased recently with routine measurement of serum calcium and increasing awareness of the disease by the public. Despite the availability of expert surgeons and preoperative imaging investigations, some patients are re-operated for persistent or recurrent hyperparathyroidism. The main cause of re-operation is the presence of ectopic parathyroid gland or supernumerary parathyroid gland. Supernumerary parathyroid glands are more frequently described in the secondary hyperparathyroidism than in the primary hyperparathyroidism cases, especially in surgery for renal hyperparathytroidism. The intraoperative measurement of intact parathyroid hormone (iPTH) provides the surgeon with a quantitative test that predicts the postoperative serum calcium level and can justify early closure or further exploration for hyperfunctioning parathyroid gland. We present a case of parathyroidectomy of supernumerary parathyroid glands by monitoring intraoperative iPTH in patients with secondary hyperparathyroidism. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:190-3