Endocrine Abstracts

Introduction: Tertiary hyperparathyroidism (HPT) occurs most commonly in the setting of renal transplant where patients with secondary HPT continue to have elevated PTH levels after receiving a renal allograft. This disease is observed in up to 30% of kidney transplant recipients. This paper will include a case report and a review of epidemiology and pathophysiology, complications and clinical findings, indications for treatment, and the drugs currently available to treat this condition.

Case report: The 35-years-old woman with a kidney transplant history (2006), subsequently with kidney graft rejection (2014), hemodialysis for 3 years, has addressed to our department in March 2017 for amenorrhea – galactorrhea syndrome (last menstrual cycle 10 years ago). The serum levels of TSH was slightly elevated (8.8 UI/l) with normal FT4, prolactin was 263 ng/ml and FSH, LH, Estradiol, IGF1, basal Cortisol at 8 a.m. were normal. The evaluation of phospho-calcic metabolism emphasized normocalcemia, hyperphosphatemia with elevated intact PTH levels (1050 pg/ml), normal serum levels of 25-hydroxy vitamin D (30 ng/ml) and increased levels of alkaline phosphatase (772 U/L). An ultrasound scan of the neck showed the hyperplasia of three parathyroid glands. 99mTc sestamibi scintigraphy was negative. Bone densitometry (DEXA L1-L4) revealed osteopenia. Pituitary MRI has described a microadenoma. Medical treatment was initiated with Cabergoline and subtotal parathyroidectomy was recommended. Long term follow-up is required for monitoring related complications.

Keywords: tertiary hyperparathyroidism, prolactinoma, subtotal parathyroidectomy.