Primary hyperparathyroidism: A report of two unusual cases

Primary hyperparathyroidism (PHPT) has a variable clinical expression. Majority of the patients are asymptomatic. Symptomatic PHPT with classical skeletal, renal, abdominal and neuro-psychiatric manifestations have become exceedingly rare. Asymptomatic maternal PHPT manifesting as neonatal hypocalcaemic convulsions is another rare entity. The commonest cause of PHPT are solitary parathyroid adenomas. These benign tumors are extremely small being difficult to identify even at surgical exploration. Very large tumors known as giant adenomas are uncommon. Double parathyroid adenomas account for only a small percentage of the lesions associated with PHPT. Considerable debate exists as to whether double adenomas are a distinct entity or represent early stages of four gland hyperplasia. We report two interesting cases of PHPT with classical features, that have become rare today such as nephrolithiasis, nephrocalcinosis, and X-ray findings of bone disease, caused by unusual pathological lesions like double and giant adenomas and discuss rare presentations like neonatal convulsions.