The Co-occurrence of Multiple Parathyroid Adenomas: A Case Report

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Primary hyperparathyroidism is typically caused by a single parathyroid adenoma.
• Multiple parathyroid adenomas are an uncommon but significant cause of persistent or recurrent hyperparathyroidism.
• Accurate localization and surgical management are crucial for successful treatment.

Observation:

• A 61-year-old female presented with hypercalcemia and elevated parathyroid hormone (PTH) levels.
• Initial surgery identified and removed one parathyroid adenoma, but intraoperative PTH monitoring indicated persistent hyperparathyroidism.
• Further exploration revealed a second, ipsilateral parathyroid adenoma, which was subsequently removed.

Findings:

• Pathology confirmed two concurrent parathyroid adenomas in the right superior and inferior glands.
• Intraoperative PTH monitoring was essential in guiding the surgical strategy to ensure complete removal.
• Successful parathyroidectomy was achieved, leading to curative treatment for primary hyperparathyroidism.

Implications:

• This case underscores the importance of considering multiple parathyroid adenomas even in seemingly straightforward cases of primary hyperparathyroidism.
• Intraoperative PTH monitoring is a valuable tool for confirming complete resection and preventing persistent disease.
• Advanced imaging techniques like four-dimensional computed tomography may improve the preoperative detection of multiple adenomas.