Immediate parathyroidectomy (PTx) may be an effective treatment for hemodialysis patients with tumoral calcinosis due to secondary hyperparathyroidism (SHPT), according to investigators.

Tumoral calcinosis is a rare complication occurring in 0.5% to 3% of HD patients. It is characterized by progressive growth of painful calcium phosphate deposits within juxta-articular areas.

In a study of 9 patients (7 men; mean age 38.6 years) at a single institution, calciphylaxis developed in 1 patient, who later died. The remaining patients underwent total PTx with autotransplantation. Of these, 5 patients experienced effective regression of tumoral calcinosis by more than 80% within 1 to 5 months (group A) and 3 showed little response (group B), Jing Wang, MD, of the First Affiliated Hospital of Nanjing Medical University in China, and colleagues reported in BMC Surgery. Shorter duration of pre-existing tumoral calcinosis (6 vs 9 months), higher serum preoperative alkaline phosphatase (ALP) levels (408.0 vs 90.8 pg/mL), and lower postoperative phosphate levels (1.4 vs 2.4 mmol/L at 6 months) significantly correlated with effective shrinkage in group A. Serum intact parathyroid hormone levels did not significantly differ between the groups.

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The investigators cited several possible reasons for tumoral calcinosis absorption. First, higher serum ALP before PTx may have led to prolonged hungry bone syndrome in group A and therefore greater dissolution of extraosseous calcification. Consistent with this hypothesis, group A required significantly higher average calcium supplementation within 1 week of surgery (96.8 vs. 20.1 g). Second, shorter duration of tumoral calcinosis in group A reflects shorter treatment duration and possibly less formation of calcium hydroxyapatite crystals. Third, increased preoperative high-sensitivity C-reactive protein (82.7 vs. 3.1 mg/L) and reduced postoperative serum phosphate levels may have promoted formation of osteoclastic cells.

“In patients with tumoral calcinosis due to secondary hyperparathyroidism, earlier PTX is suggested to be an effective strategy for the treatment of TC [tumoral calcinosis],” Dr Wang’s team said.

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Wang J, Zeng M, Yang  G, et al. Effects of parathyroidectomy on tumoral calcinosis in uremic patients with secondary hyperparathyroidism. BMC Surg. 19:133. doi:10.1186/s12893-019-0603-8