Severe Persistent Tetriary HPT after Subtotal Parathyroidectomy, Resistant to Medical Treatment

Relevance. Tertiary hyperparathyroidism (TНPT) is one of the serious complications of terminal chronic kidney disease and renal replacement therapy. Despite the opportunities of surgical and medical treatment in some cases TНPT has persistent clinic and poor controlled correction. The purpose of the study To describe the case of persistent serious tertiary hyperparathyroidism clinic. Materials and methods The patient with serious tertiary hyperparathyroidism is described who gets extracorporal dialysis from 2002. Results and their discussion In 2008 parathyroid adenoma and high level of parathyroid hormone (PTH) - 1580 pg/l revealed. In September 2009 he underwent parathyroidectomy (PTE) with removal of two parathyroid adenomas. Because of early hyperparathyroidism recurrence he got Cinacalcet therapy course for 17 months. In 2011 CT-scan revealed new adenomas. We had to repeat PTE but within 3 months after operation PTH level increased from 950 to 1467pg/l. Operations and pre- and postoperative treatment did not allowed to correct the indexes of bone metabolism. Conclusion Severe persistent THPT in some cases is refractory to both invasive and therapeutic treatments. The case demonstrates the potential difficulties in modern diagnosis and choice between conservative and surgical treatment of this pathology

Tertiary hyperparathyroidism, parathyroidectomy, conservative treatment