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Tertiary Renal Hyperparathyroidism: The Case of Irradiation-Induced Hyperparathyroidism With Differential Diagnosis of Parathyroid Carcinoma in the Patient Occupationally Over Exposed to Ionizing Radiation

Jurisic-Erzen, Dubravka MD, PhD*; Lucin, Ksenija†; Lalic, Hrvoje‡; Ljubic, Spomenka§; Azman, Josip¶; Jerkovic, Romana PhD∥

doi: 10.1097/TEN.0b013e3181b622a9
Case Report

Radiation-induced hyperparathyroidism in tertiary renal hyperparathyroidism was diagnosed in a patient that was exposed to ionizing radiation for 25 years. After preoperative localization, surgical excision showed an enlarged right lower parathyroid gland with invasion into the surrounding structures. Pathohistological examination established the diagnosis of parathyroid hyperplasia, but the main differential diagnosis of parathyroid carcinoma was due to the type of growth seen in patients who were over exposed to x-irradiation. During the next 5 years, regularly checking biochemical markers and imaging studies every 6 months, no further local growth or metastases of parathyroid carcinoma were found.

This report demonstrates, for the first time, the effect of low dose ionizing radiation on parathyroid health.

From the *Department of Internal Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia; Departments of †Pathology and ‡Occupational Medicine, University of Rijeka, Rijeka, Croatia; §Department of Metabolic, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Zagreb, Croatia; and Departments of ¶Anaesthesia and ICU and ∥Anatomy, University of Rijeka, Rijeka University Hospital, Rijeka, Croatia.

Reprints: Jurisic-Erzen Dubravka, MD, PhD, Department of Internal Medicine, Clinical Hospital Centre Rijeka, Brestovice 54, 51215 Kastav, Croatia. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.