CLINICAL PROFILE AND OUTCOME OF PRIMARY HYPERPARATHYROIDISM ACCOMPANIED BY CHRONIC-RENAL-FAILURE

We encountered 5 cases of primary hyperparathyroidism (PHPT) accompani ed by chronic renal failure over the past 4 years. Neither hypocalcemi a nor hyperphosphatemia was found in the past records. The parathyroid hormone (PTH) levels in these cases were extraordinarily higher than those in usual patients suffering from renal failure. The manifestatio n of PHPT developed insidiously together with the decline of renal fun ction. Serum 1,25(OH)(2)D-3 levels were lower than normal range in all cases, and which in turn might accelerate the progression of PHPT in a similar way as the development of secondary hyperparathyroidism. Par athyroidectomy (PTX) was done successfully in 4 cases, and the patholo gy of the biggest gland was adenoma but hyperplasia was found in other glands simultaneously. These results revealed the polymorphism of par athyroid glands in case of complication with renal failure. Furthermor e, the interruption of postoperative 1 alpha(OH)D-3 treatment induced the relapse of hyperparathyroidism (HPT). The case which refused PTX w as treated by oral pulse therapy with 1,25(OH)(2)D-3. The calcium/inta ct PTH sigmoidal curve examined 3 years later revealed that the set po int shifted to right and upward despite therapy. It suggested that fun ctional parathyroid mass became larger and the sensitivity to calcium became less under continuous stimuli on parathyroid glands. According to these results, PHPT accompanying with renal failure is resistant to medical therapy, and surgical treatment is a possibility. In this occ asion, total PTX with autograft transplantation is better than simple adenectomy because even the glands not responsible to clinical manifes tation of PHPT can have some pathological abnormalities. Though the in cidence rate of overt HPT in our institutes was low at pre-dialysis st age (0.2%, 10/582), a detailed individual review of patients records m ight facilitate a differential diagnosis as to whether HPT is primary or secondary, and might help to select a precise therapeutic method.