Complete reversal of bone marrow fibrosis after parathyroidectomy for secondary hyperparathyroidism

Azevedo, Paula D. G. G.; Cardoso, Patrícia Santos Resende; Farah, Kátia de Paula; Melo, Frederico Henrique Corrêa de; Rezende, Suely Meireles

doi:10.1111/bjh.14774

Cited by 7 publications

(9 citation statements)

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“…Myelofibrosis resulting from secondary HPT caused by ESRD is an uncommon disease in young individuals (aged < 20 years old), and only few cases have been reported ( Table 1 ) ( 12 – 14 ). Treatment of HPT in renal disease consists of dietary modification, phosphate binders, and active vitamin D ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Parathyroidectomy ameliorates anemia and reduces the requirement of postoperative erythropoiesis-stimulating agents ( 17 ). There have been reports of patients with myelofibrosis caused by secondary HPT, who were successfully treated using a parathyroidectomy ( 13 , 14 , 18 ). However, cinacalcet has been effective even in patients with marked parathyroid hyperplasia, suggesting that it may serve as an alternative to parathyroidectomy for treatment of severe secondary HPT ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Effects of Secondary Hyperparathyroidism Treatment on Improvement of Juvenile Nephronophthisis-Induced Pancytopenia and Myelofibrosis

et al. 2021

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Secondary hyperparathyroidism (HPT) is a common complication of end-stage renal disease (ESRD) and may be an important precipitating factor for the development of myelofibrosis. However, there have been only a few reports on myelofibrosis caused by secondary HPT in children. We describe a case of a 15-year-old boy with myelofibrosis due to secondary HPT who was successfully treated with hemodialysis, erythropoietin, phosphate binders, and activated vitamin D agents. The patient had no past medical history and had been admitted to the hospital for abdominal pain. Routine blood examination revealed pancytopenia combined with renal impairment. Hyperphosphatemia, decreased 1,25-dehydroxyvitamin D, decreased serum calcium, and increased parathyroid hormone (PTH) levels were observed. Bone marrow biopsy confirmed myelofibrosis and renal biopsy revealed nephronophthisis (NPHP). The possibility of renal osteodystrophy and myelofibrosis due to secondary HPT was considered. Hemodialysis and erythropoietin were initiated and combined therapy with a phosphate binder and an active vitamin D agent achieved greater reduction of PTH levels, along with improvement of pancytopenia. As medical treatment for secondary HPT can lead to a reversal of myelofibrosis and avoid parathyroidectomy in children, prompt recognition of this condition has major implications for treatment. Therefore, despite its rarity, pediatricians should consider myelofibrosis due to secondary HPT as a cause of pancytopenia in patients with chronic kidney disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case Report: Effects of Secondary Hyperparathyroidism Treatment on Improvement of Juvenile Nephronophthisis-Induced Pancytopenia and Myelofibrosis

et al. 2021

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“…3,4 The optimal treatment of myelofibrosis in secondary hyperparathyroidism is variable. Myelofibrosis was found to be ameliorated in patients with CKD after renal transplantation 1 and parathyroidectomy 5,6 ; however, myelofibrosis developed or persisted in patients on chronic dialysis. 1,2,5,6 Myelofibrosis was also hypothesized to negatively affect outcomes of kidney transplantation.…”

Section: Reversible Myelofibrosis In Pediatric Renal Osteodystrophymentioning

confidence: 99%

“…Myelofibrosis was found to be ameliorated in patients with CKD after renal transplantation 1 and parathyroidectomy 5,6 ; however, myelofibrosis developed or persisted in patients on chronic dialysis. 1,2,5,6 Myelofibrosis was also hypothesized to negatively affect outcomes of kidney transplantation. 7 Awareness of this rare complica-tion in patients with CKD with pancytopenia or EPOresistant anemia can limit unnecessary workup and should prompt intensive management of hyperparathyroidism, which may lead to reversal of myelofibrosis.…”

Section: Reversible Myelofibrosis In Pediatric Renal Osteodystrophymentioning

confidence: 99%

Reversible Myelofibrosis in Pediatric Renal Osteodystrophy

Sabulski

Hughley

Nehus

et al. 2020

The Journal of Pediatrics

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“…When the PTH level is >800 pg/ml, only 22% of patients respond to cinacalcet therapy, which leads to a PTH level of <300 pg/ml. 8 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

Myelofibrosis-Induced Erythropoietin-Resistant Anemia Due to Severe Refractory Hyperparathyroidism

Sethi

Bansal

Wadhwani

et al. 2018

Kidney International Reports

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Complete reversal of bone marrow fibrosis after parathyroidectomy for secondary hyperparathyroidism

Cited by 7 publications

References 0 publications

Case Report: Effects of Secondary Hyperparathyroidism Treatment on Improvement of Juvenile Nephronophthisis-Induced Pancytopenia and Myelofibrosis

Case Report: Effects of Secondary Hyperparathyroidism Treatment on Improvement of Juvenile Nephronophthisis-Induced Pancytopenia and Myelofibrosis

Reversible Myelofibrosis in Pediatric Renal Osteodystrophy

Myelofibrosis-Induced Erythropoietin-Resistant Anemia Due to Severe Refractory Hyperparathyroidism

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