Parathyroid carcinoma, adenoma and hyperplasia in a case of chronic renal insufficiency on dialysis.

A 62 year-old female patient with polycystic disease and chronic renal insufficiency who had required dialysis for 3 years, presented with diffuse but predominantly lumbar bone pain associated with lassitude. Radiologic studies showed diffuse osteoporosis and destruction of the 4th lumbar vertebra. Calcium levels were normal (2.30-2.50 mmoles) with increased PTH levels (1820 microliter Eq/ml). The presence of a cervical mass suggested a diagnosis of hyperparathyroidism. A cervical exploration was performed with ablation of 4 parathyroid glands and autotransplantation of a portion of the left inferior gland into the arm. Pathological studies showed the existence of carcinoma in the right superior and inferior glands, adenoma of the left superior gland and hyperplasia of the left inferior gland. The association of hyperplasia, adenoma and carcinoma could be explained by an initial hyperplasia of the 4 glands due to renal insufficiency, with subsequent transformation of 3 into adenomas of which 2 became cancerous. The patient's status was significantly improved following surgery.