Progression of Secondary to Tertiary Hyperparathyroidism with a Coexisting Parathyroid Adenoma in Stage 3B Chronic Kidney Disease: A Case Report

Authors

  • Reniza Puteri Yuliantari 1. Clinical Pathology Specialization Programme, Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 2. Department of Clinical Pathology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
  • Fauqa Arinil Aulia 1. Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 2. Department of Clinical Pathology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
  • Muhamad Robi’ul Fuadi Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
  • Ferdy Royland Marpaung 1. Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 2. Department of Clinical Pathology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
  • Jongky Hendro Prajitno Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
  • Yessy Puspitasari 1. Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. 2. Department of Clinical Pathology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Keywords:

Hyperparathyroidism, secondary, parathyroid neoplasm, Adenoma, parathyroidectomy, renal insufficiency, chronic, hypercalcemia

Abstract

Tertiary hyperparathyroidism arises when prolonged secondary hyperparathyroidism progresses to autonomous parathyroid hormone secretion with persistent hypercalcemia, most often in chronic kidney disease. Diffuse or nodular multiglandular hyperplasia is the expected pathology; a discrete parathyroid adenoma arising within hyperplastic tissue is uncommon and may be overlooked when imaging is negative early in the disease course.A 60-year-old man with stage 3b chronic kidney disease and long-standing secondary hyperparathyroidism presented with recurrent hypercalcemia and severe vomiting. Laboratory evaluation confirmed elevated serum calcium and parathyroid hormone. Initial cervical ultrasonography showed no parathyroid enlargement, but repeat imaging demonstrated a progressively enlarging lesion adjacent to the left thyroid lobe. He underwent subtotal parathyroidectomy with bilateral cervical exploration. Histopathology showed multiglandular hyperplasia of the right parathyroid glands together with a distinct encapsulated adenoma arising within hyperplastic left parathyroid tissue. Serum calcium normalized postoperatively.

References

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Published

2026-09-28

How to Cite

Yuliantari, R. P., Aulia, F. A. ., Fuadi, M. R. ., Marpaung, F. R. ., Prajitno, J. H. ., & Puspitasari, Y. . (2026). Progression of Secondary to Tertiary Hyperparathyroidism with a Coexisting Parathyroid Adenoma in Stage 3B Chronic Kidney Disease: A Case Report. Acta Medica Indonesiana, 58(3), 436. Retrieved from http://www.actamedindones.org/index.php/ijim/article/view/3360

Issue

Vol. 58 No. 3 (2026): Acta Medica Indonesiana

Section

CASE REPORT

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Copyright (c) 2026 Reniza Puteri Yuliantari, Fauqa Arinil Aulia, Muhamad Robi’ul Fuadi, Ferdy Royland Marpaung, Jongky Hendro Prajitno, Yessy Puspitasari

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