Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

Area of Science:

• Endocrinology
• Oncology
• Bone Metabolism

Background:

• Normocalcemic primary hyperparathyroidism (NPHPT) is defined by elevated parathyroid hormone (PTH) with normal serum calcium.
• NPHPT can lead to significant bone loss and chronic pain, impacting quality of life.

Observation:

• A 77-year-old postmenopausal woman with NPHPT presented with chronic pain and osteoporosis.
• Initial workup was negative for secondary causes, and imaging was unrevealing for parathyroid adenomas.
• Despite treatment for osteoporosis, she developed multiple parathyroid adenomas over a decade, confirmed by fine-needle aspiration and parathyroidectomy.

Findings:

• The patient underwent two parathyroidectomies for histologically confirmed parathyroid adenomas.
• Post-operatively, serum PTH remained elevated with normal calcium levels, indicating persistent NPHPT.
• This case illustrates a rare, long-term progression of NPHPT with multiple adenomas.

Implications:

• This case underscores the importance of long-term monitoring in NPHPT patients.
• It highlights the diagnostic challenges and potential for multiple adenomas in NPHPT.
• Understanding such rare presentations is crucial for effective patient management and treatment strategies.