Dramatic reduction of the tumoral calcification treated with sevelamer hydrochloride and surgical removal of autotransplanted parathyroid tissue

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  • Fukui Akira
    Department of Nephrology, Numazu City Hospital Department of Internal Medicine, Division of Kidney and Hypertension, The Jikei University School of Medicine
  • Wakabayashi Yoshinori
    Department of Nephrology, Numazu City Hospital
  • Tsukada Yukiko
    Department of Nephrology, Numazu City Hospital
  • Suetsugu Yasuko
    Department of Nephrology, Numazu City Hospital
  • Hayashi Yoshiaki
    Department of Endocrinology and Metabolism, Numazu City Hospital
  • Tsumurai Yoshiharu
    Department of Orthopedics, Numazu City Hospital
  • Yokoyama Keitaro
    Department of Internal Medicine, Division of Kidney and Hypertension, The Jikei University School of Medicine
  • Hosoya Tatsuo
    Department of Internal Medicine, Division of Kidney and Hypertension, The Jikei University School of Medicine

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Other Title
  • Ｓｅｖｅｌａｍｅｒ　ｈｙｄｒｏｃｈｌｏｒｉｄｅの投与と前腕副甲状腺移植片の外科的摘出により劇的に縮小した腫瘤状石灰化の１例
  • ショウレイ ホウコク Sevelamer hydrochloride ノ トウヨ ト ゼンワン フクコウジョウセン イショクヘン ノ ゲカテキ テキシュツ ニ ヨリ ゲキテキ ニ シュクショウ シタ シュリュウジョウ セッカイカ ノ 1レイ

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Abstract

The patient was a 57-year-old man on maintenance dialysis since 1979. To control secondary hyperparathyroidism, he underwent total parathyroidectomy with autotransplantation to his left arm in 1994. He underwent a second parathyroidectomy for the remaining parathyroid tissue in 1999. In June 2003, he started to complain of gait disturbance with a pain in the right hip. On examination at our hospital in December 2003, the serum calcium level was 13.2mg/dL, phosphate level 6.1mg/dL, albumin level 4.4g/dL and the intact parathyroid hormone (i-PTH) level 360pg/mL. X-ray film showed a fist-sized tumoral calcification extending from the right hip to the thigh. After we discontinued vitamin D derivatives, bisphosphonate and aluminium-containing phosphate binder, sevelamer hydrochloride was administered. Serum calcium and phosphate were normalized. In contrast, the i-PTH level increased to 2, 022pg/mL, in December 2004, therefore the patient underwent surgical removal of autotransplanted parathyroid tissue. The tumoral calcification reduced dramatically after several months. Administration of sevelamer hydrochloride and surgical removal of autotransplanted parathyroid tissue have been thought to treat the tumoral calcification related to vitamine D overdose and secondary hyperparathyroidism.

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