Giant parathyroid adenoma: a case report

Area of Science:

• Endocrinology
• Surgical Pathology

Background:

• Giant parathyroid adenoma is defined as a parathyroid adenoma weighing more than 3.5g and measuring over 2cm.
• These large tumors can cause significant hypercalcemia due to excessive parathyroid hormone production.

Observation:

• A 48-year-old man presented with knee and lower back pain, a history of mitral valve replacement, and recurrent nephrolithiasis.
• A large neck mass initially suspected to be thyroid in origin was identified.
• Surgical resection revealed a 122g giant parathyroid adenoma (9x6x4 cm), confirmed by histopathology.

Findings:

• The resected giant parathyroid adenoma weighed 122g, significantly exceeding the typical definition.
• Despite the large size and high parathyroid hormone levels, the patient did not experience a calcium crisis.
• Initial assessment led to a potential misdiagnosis as a thyroid mass.

Implications:

• Giant parathyroid adenomas, particularly those exceeding 110g and 8cm, necessitate careful evaluation due to potential for severe hypercalcemia.
• The presentation underscores the importance of considering parathyroid origin in large neck masses, even when thyroid pathology is suspected.
• Clinical presentation can vary, with some patients with giant adenomas not exhibiting a calcium crisis.