This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal My Folders Download to citation manager Google Scholar Articles by Fok, W. M. M. Articles by Leung, H. B. PubMed PubMed Citation Articles by Fok, W. M. M. Articles by Leung, H. B.

Unresolved lytic lesions following parathyroidectomy in a patient with chronic renal failure

¹ Department of Orthopaedics and Traumatology, 51F, Professional Block, Queen Mary Hospital, Pokfulam Road, Hong Kong, China.

Correspondence should be sent to Dr. W. M. M. Fok; e-mail: margaretfok{at}netscape.net

With advances in the treatment of patients with chronic renal failure, their life expectancy has increased. In turn, the prevalence of osteitis fibrosa cystica, a manifestation of secondary hyperparathyroidism, and β2 microglobulin amyloidosis, a result of long-term haemodialysis, has risen. While both conditions share similar radiological features, their management is very different.

We present the case of a patient with renal failure who had been receiving haemodialysis for over 20 years. Lytic lesions had been observed in the proximal part of both femurs for ten years. A presumptive diagnosis of osteitis fibrosa cystica was made. However, no regression of the lesions occurred after parathyroidectomy. The patient subsequently developed sequential pathological fractures through the lesions, for which bilateral total hip replacements were performed. Histology of the lesions revealed that the patient was in fact suffering from amyloidosis.

In patients with chronic renal failure, osseous amyloidosis is a highly probable differential diagnosis, especially if no regression of a lytic lesion is observed after parathyroidectomy.