A 23-year-old patient with secondary tumoral calcinosis: Regression after subtotal parathyroidectomy: A case report. (2016)

• Record Type: Journal Article
• Authors: Niemann, Katharina E.; Kröpil, Feride; Hoffmann, Martin F.; Coulibaly, Marlon O.; Schildhauer, Thomas A.
• Is Part Of: International journal of surgery case reports. Volume 23(2016)
• Page Start: 56
• Page End: 60
• Publication Date: 2016
• Subjects: TC tumoral calcinosis -- sP subtotal parathyroidectomy -- FGF23 fibroblast growth factor 23 -- GALNT3 GalNAc transferase 3 -- KL KLOTHO -- THR total hip replacement -- ROM range of motion -- CRP C reactive protein -- WBC white blood cells -- PTH parathyroid hormone -- CT computed tomography; Tumoral calcinosis -- Chronic kidney disease -- Parathyroidectomy -- Case report -- Teutschlaender disease; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2016.04.011
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Tumoral calcinosis needs to be diagnosed correctly. Subtotal parathyroidectomy leads to rapid regression. Potential mutilations may be avoid by early subtotal parathyroidectomy. Abstract: Introduction: Tumoral calcinosis (TC) is a rare disorder defined by hyperphosphatemia and ectopic calcifications in various locations. The most common form of TC is associated with disorders such as renal insufficiency, hyperparathyroidism, or hypervitaminosis D. The primary (hereditary) TC is caused by inactivating mutations in either the fibroblast growth factor 23 ( FGF23), the GalNAc transferase 3 ( GALNT3) or the KLOTHO ( KL) gene. Presentation of case: We report here a case of secondary TC in end-stage renal disease. The patient was on regular hemodialysis and presented with severe painful soft-tissue calcifications around her left hip and shoulder that had been increasing over the last two years. Initially, she was treated with dietary phosphate restriction and phosphate binders. Because of high phosphate blood levels, which were not yet managed with dialysis and medical therapy, a subtotal parathyroidectomy (sP) was performed. This approach demonstrated significant response. Three months after surgery a rapid regression of the tumors was observed. Disscusion: Regardless of the etiology, the two types of TC do not differ in their radiologic or histopathologic presentations but need to be diagnosed correctly to initiate targeted and effective treatment. Considering the primary TC, primary treatment is early and complete surgical excision. In case of secondary TC surgical excision of the tumoral masses should be avoid because of extensive complications. These patients benefit from sP. Conclusion: After initial conservative therapy chronic kidney disease patients with TC might benefit from sP to avoid prolonged suffering and potential mutilations.