PARATHYROIDECTOMY FOR TERTIARY HYPERPARATHYROIDISM IN A PATIENT WITH CHRONIC KIDNEY DISEASE AND RENAL OSTEODYSTROPHY: A CASE REPORT

Abstract

Background: Chronic kidney disease-mineral and bone disorder (CKD-MBD) poses a major therapeutic challenge in hemodialysis patients. Untreated secondary hyperparathyroidism (SHPT) can progress to tertiary hyperparathyroidism (THPT), characterized by the autonomous secretion of parathyroid hormone (PTH) despite correction of biochemical abnormalities. Case Presentation: We report the case of a 59-year-old male with end-stage renal disease (ESRD) on hemodialysis for eight years, who developed severe THPT and a pathologic femoral neck fracture secondary to renal osteodystrophy. Laboratory results revealed markedly elevated PTH (4,876 pg/mL preoperatively and 8 pg/mL postoperatively), hypercalcemia, and hyperphosphatemia despite optimized medical therapy. The patient underwent subtotal parathyroidectomy (3½ glands removed) with histopathologic confirmation of nodular hyperplasia. Postoperatively, he developed hungry bone syndrome, successfully managed with intravenous and oral calcium and calcitriol. At three-month follow-up, PTH decreased to 215 pg/mL with normalization of calcium and phosphorus and significant clinical improvement. Conclusion: Parathyroidectomy remains the definitive treatment for refractory tertiary hyperparathyroidism, providing biochemical control and symptom relief. This case highlights the multidisciplinary management required in CKD-MBD, integrating nephrology, endocrinology, and orthopedic