Tertiary hyperparathyroidism diagnosed after renal homotransplantation

A twenty-eight year old patient with irreversible chronic renal failure formed calcium-phosphate calculi two months after a successful renal homotransplantation. Biochemical findings supported the diagnosis of autonomous parathyroid hyperfunction. After surgical resection of one parathyroid gland, containing an encapsulated chief cell adenoma, no further renal calculi were formed and serum calcium and phosphate levels returned to normal, remaining so up to the patient's death nine months later. Unlike other patients with renal transplants who had hyperparathyroidism caused by secondary hyperplasia, the “tertiary” hyperparathyroidism in this patient (autonomous adenoma formed in chronically overstimulated glands) was uncovered after restoration of normal renal function.