Primary hyperparathyroidism: A report of two unusual cases

Area of Science:

• Endocrinology
• Pathology
• Surgical Oncology

Background:

• Primary hyperparathyroidism (PHPT) typically presents asymptomatically, with classical severe manifestations becoming rare.
• Solitary parathyroid adenomas are the most common cause, often small and difficult to locate.
• Giant adenomas and double adenomas are uncommon causes of PHPT.

Purpose of the Study:

• To report rare cases of PHPT caused by double and giant parathyroid adenomas.
• To discuss classical PHPT manifestations that are now rare.
• To highlight unusual presentations, including neonatal hypocalcemic convulsions.

Main Methods:

• Case report analysis of two patients with PHPT.
• Review of pathological findings including double and giant parathyroid adenomas.
• Discussion of clinical presentations and diagnostic challenges.

Main Results:

• Two cases of PHPT with classical features (nephrolithiasis, nephrocalcinosis, bone disease) were identified.
• Pathological lesions included double parathyroid adenomas and a giant parathyroid adenoma.
• Rare presentations such as neonatal convulsions associated with maternal PHPT were discussed.

Conclusions:

• Double and giant adenomas are rare but significant causes of PHPT, presenting with classical, albeit uncommon, symptoms.
• PHPT in pregnancy can lead to severe neonatal complications.
• Increased awareness of rare etiologies and presentations is crucial for timely diagnosis and management of PHPT.