Maxillofacial Enlargement in Secondary Hyperparathyroidism Successfully Treated by Limited Parathyroidectomy and Paricalcitol

Korean Journal of Nephrology 2011;30(6):671-675.

Se Won Oh, M.D.1, Young Mo Lee, M.D.1, Jeong Yup Kim, M.D.1, Joon Kwang Wang, M.D.1, Ko Gang Jee, M.D.1, Heui Jung Pyo, M.D.1, Sang Il Suh, M.D.2, Seong Eun Kim, M.D.3, Jae Bok Lee, M.D.4, Ji Eun Lee, M.D.5, Seung Won Lee, M.D.6 and Young Joo Kwon, M.D.1

Departments of Internal Medicine¹
Radiology²
Nuclear Medicine³
Division of Endocrine Surgery⁴
Korea University College of Medicine, Korea University Medical Center, Department of Internal Medicine⁵
Won-Kwang University College of Medicine Departments of Internal Medicine⁶
Bupyung Serim General Hospital

증례 : Maxillofacial Enlargement in Secondary Hyperparathyroidism Successfully Treated by Limited Parathyroidectomy and Paricalcitol

Departments of Internal Medicine1, Radiology2, Nuclear Medicine3, Division of Endocrine Surgery4, Korea University College of Medicine, Korea University Medical Center, Department of Internal Medicine5, Won-Kwang University College of Medicine Departments

Abstract

Maxillary enlargement is a rare complication of secondary hyperparathyroidism (SHPT). A 35-year-old Korean man undergoing chronic hemodialysis presented with a painless enlargement involving the maxilla and mandible. Plain radiography and CT scan showed bony expansion at the maxilla and mandible with multiple radiolucency. Serum intact parathyroid hormone (iPTH) was >1,600 pg/mL. Tc- 99m sestamibi (MIBI) parathyroid scan and neck sonogram were compatible with SHPT. He underwent limited parathyroidectomy and commenced a course of paricalcitol. Fifteen months after surgery, maxillary enlargement and bony resorptions involving both hands markedly improved. Thirty-six months after the surgery, the serum iPTH level was 109.3 pg/mL. This is the first report in Korea documenting a patient with maxillary enlargement in SHPT who was successfully treated with limited parathyroidectomy and paricalcitol.

Key Words: Renal osteodystrophy, Hyperparathyroidism, secondary, Maxillas