Hiperparatireoidismo secundário à doença renal crônica: relato de caso

Abstract

Secondary hyperparathyroidism is a frequent complication in patients with chronic kidney disease. The objective of this study is to report a case of hyperparathyroidism secondary to chronic kidney disease in which the patient has developed brown tumor in the maxilla and mandible; and to describe how delayed parathyroidectomy significantly reduced their quality of life. A 46-year-old male patient with systemic arterial hypertension and chronic renal failure on dialysis for approximately 26 years presented secondary hyperparathyroidism, evolving with musculoskeletal symptoms and brown tumor in the maxilla and mandible. After failure of the clinical treatment, he received an indication for parathyroidectomy, but found difficulty in accessing the head and neck surgery service, remaining for five years in the waiting line. Through a lawsuit, he obtained a preliminary injunction favorable to the accomplishment of the surgery. Three years after parathyroidectomy, there was a significant improvement in clinical symptoms with reduction of brown tumor. Despite advances in the clinical treatment of secondary hyperparathyroidism, therapeutic failure occurs in a significant portion of the patients, making parathyroidectomy a necessary resource. However, limited access to head and neck surgery services cause patients to remain in the waiting line for a long time, what increases their morbidity. It is fundamental that the organization of the Health System is improved by the managers, through public policies like the creation of reference services for the accomplishment of parathyroidectomy in patients with hyperparathyroidism secondary to chronic kidney disease, aiming to reduce morbidity and mortality in these patients and to improve their quality of life.