We present the third case and first reported survivor of penile gangrene due to secondary hyperparathyroidism from chronic renal failure. The patient was treated with distal penectomy and subtotal parathyroidectomy. This case stimulated us to review the metabolic and vascular changes associated with secondary hyperparathyroidism in chronic renal failure. Secondary hyperparathyroidism may cause diffuse vasculitis and vascular calcification, which can lead to widespread ischemic necrosis and gangrene. Early medical therapy, including oral phosphate binders, is crucial to maintain the serum calcium-phosphate product below precipitation level. Subtotal parathyroidectomy is indicated for patients in whom progresive arterial and soft tissue calcification develops despite medical therapy.
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