Effects of parathyroidectomy on tumoral calcinosis in uremic patients with secondary hyperparathyroidism

Abstract

Background Tumoral calcinosis (TC) is a rare disease derived from uremic secondary hyperparathyroidism (SHPT). However, parathyroidectomy (PTX) seems to be ineffective at relieving TC in some patients. In this study, we investigated the relationship between PTX and TC shrinkage. Methods We retrospectively followed up nine TC patients who underwent PTX, dividing them into two groups: those with TC size reduced by > 80% were in the “effective group” (group A), and the rest in the “ineffective group” (group B). Results We enrolled nine patients (7 men; mean age 38.6 ± 10.9 years) with SHPT-related TC. One patient with calciphylaxis was excluded due to sudden death. The efficiency of PTX in causing TC regression was 62.5% (5 patients in group A). Group A had a shorter overall duration of TC (6 [5.5, 6.0] vs. 9 [8.0, 10.0] months; P = 0.02) and higher serum levels of alkaline phosphatase (ALP; 408.0 [217.9, 1101.7] vs. 90.8 [71.0, 102.1] pg/ml; P = 0.03) and high-sensitivity C-reactive protein (hs-CRP; 82.7 [55.0, 112.4] vs. 3.1 [3.1, 4.5] mg/l; P = 0.02). Average calcium supplementation within 1 week of surgery was significantly greater in group A than in group B (96.8 [64.1, 105.3] vs. 20.1 [13.1, 32.7] g; P = 0.04). Patients in both the groups demonstrated similar serum phosphate levels before PTX, but these levels were higher in group B than in group A at follow-up times (3 months, P = 0.03; 6 months, P = 0.03). Conclusions The shorter duration of pre-existing TC and higher ALP levels before PTX, as well as lower serum phosphate levels after PTX, were correlated with effective SHPT-TC shrinkage.

Treatment of Uremic Tumoral Calcinosis in Maintenance Hemodialysis Patients

“…In our study, when patients with high iPTH levels were refractory to treatment by internal medicine, they underwent PTX (tPTX or tPTX with AT). Consistent with previous studies [3,23,24], PTX is an effective treatment for alleviating SHPT patients with UTC. There was a significant decrease in Although UTC most frequently occurs in parallel to SHPT, high rates of soft-tissue calcifications are increasingly reported in low turnover adynamic or osteomalacia bone disease [5,13,14].…”

“…Although a relatively rare complication, UTC may cause severe clinical symptoms, such as limitations in joint movement, skin ulceration, pyrexia, bone destruction, and intolerable pain [19]. The pathogenesis of UTC is commonly associated with an increase of Ca-P product and SHPT [3,[10][11][12].…”

“…Life expectancy in hemodialysis (HD) patients has increased, and dialysis-related complications have increased significantly. Uremic tumoral calcinosis (UTC) is a well-known but rare end-stage renal disease-related complication in mineral and bone metabolism [1][2][3]. It represents solitary or multifocal calcium phosphate (Ca-P) deposits in soft tissues.…”

“…UTC often presents as painful tumor-like masses around both smaller over-used joints and large weight-bearing joints [8,9]. The pathogenesis of UTC is commonly associated with an increase of Ca-P product and secondary hyperparathyroidism (SHPT) [3,[10][11][12]. However, high rates of soft-tissue calcifications are increasingly reported in low turnover adynamic or osteomalacia bone disease [5,13,14].…”

Parathyroidectomy May Cause Remission of Uraemic Tumoral Calcinosis in Haemodialysis Patients

“…The authors concluded that PTX is usually effective only in dialysis patients with severe hyperparathyroidism and high serum ALP levels. Wang et al [23] retrospectively analysed the clinical data of eight UTC patients treated with PTX and found that five showed complete tumour absorption within 1-6 months after surgery, while the other four showed no significant tumour absorption. They reported that the PTX effectiveness rate for the treatment of UTC was 62.5% and that the non-absorption of UTC after PTX was related to a history of lower ALP levels and UTC.…”