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PARATHYROMATOSIS: A RARE CASE OF RECURRENT HYPERPARATHYROIDISM LOCALIZED BY FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY.

Abraham E Wei, Matthew R Garrett, Ankur Gupta

AACE Clinical Case Reports

|January 23, 2020

Summary

Parathyromatosis, a rare cause of recurrent hyperparathyroidism, was successfully localized using four-dimensional computed tomography (4DCT). This imaging technique aids in identifying and surgically managing this challenging condition.

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Area of Science:

Endocrinology
Surgical Oncology
Radiology

Background:

Parathyromatosis is a rare condition characterized by the diffuse spread of parathyroid tissue, often leading to recurrent hyperparathyroidism.
Diagnosis and surgical management of parathyromatosis can be challenging due to the diffuse nature of the ectopic parathyroid tissue.

Observation:

A 33-year-old male with a history of parathyroid adenoma removal presented with severe hypercalcemia and elevated parathyroid hormone (PTH).
Conventional imaging (Ultrasound, CT, sestamibi, PET) was unremarkable, but four-dimensional CT (4DCT) identified hypervascularity suggestive of parathyromatosis.
Surgical exploration and resection of affected tissue resulted in a decrease in PTH and calcium levels, though not normalization.

Findings:

Pathology confirmed parathyromatosis with atypical hyperplastic parathyroid tissue in the thyroid and neck soft tissues.
This case highlights the first-time use of 4DCT for localizing parathyromatosis.

Implications:

4DCT is a valuable tool for the localization and perioperative management of parathyromatosis.
Improved imaging may lead to more complete surgical resection and better patient outcomes, preventing recurrence.
Early and accurate diagnosis through advanced imaging is crucial for managing recurrent hyperparathyroidism caused by parathyromatosis.