An important cause of recurrent hyperparathyroidism : autograft hyperplasia
Erdem Sarı1, Mehmet Hacıyanlı2, Melike Bedel Koruyucu3, Özcan Dere4, Onur Dülgeroğlu2, Yusuf Kumkumoğlu2, Özlem Gür2
Keywords: Recurrent, recurrense, hyperparathyroidism, autograft, forearm, sestamibi
Recurrent hyperparathyroidism is defined as elevated calcium and PTH levels more than 6 months after initial operation. It is usually caused by missing out abnormal parathyroid tissue in patients with multiglandular disease during operation. Other causes of recurrent hyperparathroidism are missing out ectopic adenomas, inability to localize normally localized adenomas, parathyroid carcinoma, hyperfunction of autotransplanted parathyroid tissues and parathyromatosis (1).
Total parathyroidectomy with autotransplantation of parathyroid tissue in the forearm is generally accepted(2-4) choice for secondary hyperparathyroidism, however there are controversies about optimal surgical procudure. Autotransplantation of parathyroid tissue in the forearm is a favorable method that reducing morbidity risk due to the reeksploration of neck.
Recurrent hyperparathyroidism may occur in parathyroid autotransplanted patients due to the hyperplasia of autograft. Forearm graft hyperplasia can be detected using 99Tcm-sestamibi scanning(5-7). The treatment of forearm graft hyperplasia requires complete excision of hyperplastic parathyroid fragments transplanted in the forearm. To mark the autograft with sutures or clips to facilitate exploring it.
In this study we reported follow-up and treatment outcomes of a patient with recurrent hyperparathyroidism, after operation for seconder hyperparathyroidism due to the autograft hyperplasia.