Hyperparathyroid crisis due to asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland

To report a rare case of primary hyperparathyroidism presenting with hyperparathyroid crisis due to parathyroid hyperplasia with ectopic glands.

We present the initial clinical manifestations, laboratory results, radiologic and surgical findings, and management in a patient who had hyperparathyroid crisis. The pertinent literature and management options are also reviewed.

A 60-year-old female presented with hyperparathyroid crisis requiring preoperative stabilization with rehydration, diuresis, bisphosphonate therapy, and ultimately hemodialysis. Parathyroidectomy revealed asymmetric 4-gland hyperplasia, with a massive ectopic parathyroid gland in the tracheoesophageal groove extending into the mediastinum. Her postoperative course was complicated by hungry bone syndrome and hypocalcemia.

This case illustrates the rare occurrence of hyperparathyroid crises due to asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland.