ODP111 PERSISTENT TERTIARY HYPERPARATHYROIDISM AFTER TOTAL PARATHYROIDECTOMY AND KIDNEY TRANSPLANTATION: THE CASE OF THE SUPERNUMERARY GLANDS

: Secondary hyperparathyroidism in patients with kidney failure and hemodialysis usually resolves after total parathyroidectomy or kidney transplantation. CASE REPORT: We report a case of a 53 year-old women polycystic kidney disease diagnosed at the age of 32, with end-stage renal disease and hemodialysis between 45-51 yrs. At the age of 50 she developed hypercalcemia (10.4-10.8 mg/dl) with very high PTH levels of 1100 pg/ml, and was referred forparathyroidectomy. Intraoperatively the four parathyroid glands were identified in canonical sites and a total parathyroidectomy was performed; postoperative total serum Calcium 8.9-9.6 mg/dl, PTH 510-680 pg/ml, suggesting the presence of a functional remnant parathyroid tissue. One year later she underwent kidney transplantation, immediate preoperative serum Calcium 10.4 mg/dl. 2 yrs later, she was referred to our clinic for hypercalcemia (11.8-12.5 mg/dl; increasing 5 mo post-transplant), high serum PTH 229-316 pg/ml) and low bone mass (lumbar spine T-score = -4.4 DS, femoral neck T-score = - 2.6 DS). She was asymptomatic and the biochemistries were: total serum calcium 12.8 mg/dl (11.8 mg/dl after hydration), serum PTH 228 pg/ml, hypophosphatemia 1.9 mg/dl, Alkaline Phosphatase 102 U/l, creatinine 1.13 mg/dl (0.85 mg/dl after hydration). 99m Tc-sestamibi SPECT-CT imaging revealed an ectopic hyperfunctional parathyroid gland above pulmonary artery bifurcation. Waiting for surgical decision, the patient was treated with denosumab 60 mg, lowering serum Calcium at 11 mg/dl at 1 mo, 11.5 mg/dl at 3 mo, PTH 511 pg/ml. CONCLUSION: This case illustrates the needfor more accurate preoperative localization of abnormal parathyroid glands in patients with tertiary hyperparathyroidism besides the standard 4-gland exploration. Presentation: No date and time listed