SECONDARY HYPERPARATHYROIDISM COMPLICATED BY PARATHYROMATOSIS

Secondary hyperparathyroidism is a common complication of chronic rena l disease, Clinical signs and symptoms tend to be severe and often are not controlled with medical measures, When medical therapy fails, par athyroidectomy becomes necessary, Recurrent hyperparathyroidism is not uncommon following surgery, One cause of surgical failure is parathyr omatosis, which has been described as multiple nodules of hyperfunctio ning parathyroid tissue scattered throughout the lower neck, superior mediastinum, or the arm if autotransplantation has been performed, Fiv e cases of parathyromatosis in patients with chronic renal failure wer e identified, Clinical characteristics, course, and prognosis of the p atients are reported, All patients had evidence of renal osteodystroph y and complained of severe pruritis and bone and/or joint pain, Three of the five patients had evidence of soft tissue calcification, two co mplained of muscle weakness, two had multiple fractures, and two event ually died of complications resulting from parathyromatosis, In four o f five cases, surgical and medical management were ineffective, The pa tients described illustrate the severe morbidity and mortality associa ted with the parathyromatosis in the setting of end-stage renal diseas e, The pathogenesis remains controversial, Although primary prevention appears to be the most effective means of avoiding this complication, it is mandatory that meticulous care be taken during surgical manipul ation, If such measures fail, calcium supplementation, calcitriol, and phosphate restriction may be tried. (C) 1996 by the National Kidney F oundation, Inc.