Evidencia de hiperplasia multinodular de paratiroides en un paciente con enfermedad renal crónica

El hiperparatiroidismo secundario en los pacientes con enfermedad renal crónica es una complicación del manejo inadecuado de los desórdenes óseos y minerales. La hiperfosfatemia persistente da lugar a hipocalcemia, con posterior elevación en los valores de paratohormona. El estímulo persiste de la glándula paratiroides favorece su diferenciación hacia formas nodulares y autónomas, las cuales poco responden a tratamientos clásicos, obligando a otras alternativas terapéuticas. Presentamos un ejemplo de la presencia de hiperplasia multinodular de glándula paratiroides, diagnosticada por estudio histológico, y ofrecemos alternativas diagnósticas y terapéuticas.

Douthat WG, Castellano M, Berenguer L, Guzmán MA, Guzmán MA, de Arteaga J, et al. Elevada prevalencia de hiperparatiroidismo secundario en pacientes con enfermedad renal crónica en diálisis en Argentina. Nefrologia 2013; 33: 657-666. DOI: 10.3265/Nefrologia.pre2013.May.12009

Isakova T, Cai X, Lee J, Metha R, Zhang X, Yang E, et al. Longitudinal evolution of markers of mineral metabolism in patients with CKD: the chronic renal insufficiency cohort (CRIC) study. Am J Kidney Dis 2020; 75: 235-244. DOI: 10.1053/j.ajkd.2019.07.022. Epub 2019 Oct 23

Arnold A, Brown M, Ureña P, Gaz RD, Sarfati E, Drueke TB. Monoclonality of parathyroid tumors in chronic renal failure and a primary parathyroid hyperplasia. J Clin Invest 1995; 95: 2047-2053. DOI: 10.1172/JCI117890

Tominaga Y, Kohara S, Namii Y, Nagasaka T, Haba T, Uchida K, et al. Clonal analysis of nodular parathyroid hiperplasia in renal hyperparathyroidism. World J Surg 1996; 20: 744-752. DOI: 10.1172/JCI116720

Fukuda N, Tanaka H, Tominaga Y, Fukagawa M, Kurokawa K, Seino Y. Decreased 1,25-dihydroxyvitamin D3 receptor density is associated with a more severe form of parathyroid hyperplasia in chronic uremic patients. J Clin Invest 1993; 92: 1436-1443. DOI: 10.1172/JCI116720

Restrepo Valencia CA, Santacruz Pacheco D, Castillo Pinilla CE, Chacon Cardona JA. Ultrasound detection of hyperplasia and correlation with clinical and laboratory finding in patients with chronic kidney disease. Rev Colomb Radiol 2011; 22: 3341-3347.

Kakuta T, Tanaka R, Kanai G, Miyamoto Y, Inagaki M, Suzuki H, Fukagawa M, Saito A. Relationship between the weight of parathyroid glands and their secretion of parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism. Ther Apher Dial 2008; 12: 385-390. DOI: 10.1111/j.1744-9987.2008.00614.x

Fang Li, Tang B, Hou D, Meng M, Xiong M, Tang J. Relationship between parathyroid mass and parathyroid hormone level in hemodialysis patients with secondary hyperparathyroidism. BMC Nephrology 2015; 16: 82. DOI: 10.1186/s12882-015-0077-6

Torregosa JV, Felez I, Fuster D. Utilidad de las técnicas de imagen en el hiperparatiroidismo secundario. Nefrología 2010; 30: 143-269. DOI: 10.3265/Nefrologia.pre2010.Jan.10231

Gogusev J, Duchambon P, Hory B, Giovannini M, Goureau Y, Safati E et al. Depressed expression of calcium receptor in parathyroid gland tissue of patients with hyperparathyroidism. Kidney Int 1997; 51: 328-336. DOI: 10.1038/ki.1997.41

Hirai T, Nakashima A, Takasugi N, Yorioka N. Response of secondary hyperparathyroidism to cinacalcet depends on parathyroid size. Nephron Clin Pract 2010; 114: c187-c193. DOI: 10.1159/000262301

Okuno S, Ishimura E, Kitatani K, Chou H, Nagasue K, Maekawa K, et al. Relationship between parathyroid gland size and responsiveness to maxacalcitol therapy in patients with secondary hyperparathyroidism. Nephrol Dial Transplant 2003; 18: 2613-2621. DOI: 10.1093/ndt/gfg451

Tominaga Y, Matsuoka S, Sato T, Uno N, Goto N, Katayama A, et al. Clinical features and hyperplastic patterns of parathyroid glands in hemodialysis patients with advanced secondary hyperparathyroidism refractory to maxacalcitol treatment and required parathyroidectomy. Ther Apher Dial 2007; 11: 266-273. DOI: 10.1111/j.1744-9987.2007.00489.x

Hong YA, Cho YS, Kim SW, Jung MY, Lee EA, Ko GJ, et al. Diameter of parathyroid glands measured by computed tomography as a predictive indicator for response to cinacalcet in dialysis patients with secondary hyperparathyroidism. Kidney Blood Press Res 2015; 40: 277-287. DOI: 10.1159/000368503

Yamamoto M, Ogata H, Mizobuchi M, Yoshida N, Kumata-Maeta C, Koiwa F, eta al. Number of enlarged parathyroid glands might be a predictor of cinacalcet response in advanced secondary hyperparathyroidism. Clin Exp Nephrol 2012; 16: 292-299. DOI: 10.1007/s10157-011-0547-5

Muñoz S H, Buitrago Villa C A, Serna Toro M J, Restrepo V C A. Arteriolopatia calcificante uremica, reporte de un caso tratado con tiosulfato de sodio. Rev Colomb Nefrol 2015; 2: 63-70. DOI: 10.22265/acnef.2.1.198

Musso C G, Restrepo Valencia CA. Arteriolopatia calcificante (calcifilaxis). Recomendaciones para su manejo. Rev Colomb Nefrol 2019; 6: 14-16. DOI: 10.22265/acnef.6.1.337

de Nubila E, Vega J, Garcia L, Murillo M, Mercado J. Therapeutic effectiveness and safety parathyroid adenoma ablation with percutaneous ethanol injection under sonographic guidance in patients with chronic renal failure, and secondary hyperparathyroidism refractory to medical treatment. Rev Colomb Radiol 2010; 21: 2945-2956.

Koiwa F, Kakuta T, Tanaka R, Yumita S. Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in haemodialysis patients with secondary hyperparathyroidism. Nephrol Dial Transplant 2006; 22: 522-528. DOI: 10.1093/ndt/gfl620

Restrepo CA, Castillo CE, Sanz MF, Velez C. Effectiveness of intraglandular ethanol in secondary hyperparathyroidism limited to one only hyperplastic gland. Acta Med Colomb 2013; 38: 61-67. DOI: 10.36104/amc.2013.285

Shiizaki K, Negi S, Mizobuchi M, Hatamura I, Narukawa N, Sakaguchi T, et al. Effect of percutaneous calcitriol injection therapy on secondary hyperparathyroidism in uraemic patients. Nephrol Dial Transplant 2003; 18 (suppl 3): iii42-iii46. DOI: 10.1093/ndt/gfg1011

Nakanishi S, Yano S, Nomura R, Tsukamoto T, Shimizu Y, Shin J, et al. Efficacy of direct injection of calcitriol into the parathyroid glands in uraemic patients with moderate to severe secondary hyperparathyroidism. Nephrol Dial Transplant 2003; 18 (suppl 3): iii47-iii49. DOI: 10.1093/ndt/gfg1012

Restrepo C A, Castillo C E, Sanz M F. Serial intranodular application of paricalcitol. ¿Is effective in the treatment of secondary refractory hyperparathyroidism?. Acta Med Colomb 2015; 40: 125-131. DOI: 10.36104/amc.2015.458

Sanint V, Restrepo CA, Chala AI. Experience with surgical parathyroidectomy in patients with chronic kidney disease and tertiary hyperparathyroidism. Acta Med Colomb 2018; 43: 136-141. DOI: 10.36104/amc.2018.1033

Enfermedad renal crónica
hiperparatiroidismo
hiperplasia multinodular