Remote Recurrent Primary Hyperparathyroidism in Auto-Transplanted Tissue

Area of Science:

• Endocrinology
• Oncology
• Genetics

Background:

• Multiple Endocrine Neoplasia type 2A (MEN2A) is a rare genetic disorder associated with medullary thyroid cancer, pheochromocytoma, and primary hyperparathyroidism.
• Surgical management of hyperparathyroidism in MEN2A often involves parathyroidectomy with auto-transplantation of remnant tissue to prevent hypocalcemia.
• Recurrence of hyperparathyroidism in auto-transplanted parathyroid tissue is a rare but recognized complication.

Observation:

• A 51-year-old male with MEN2A presented with asymptomatic hypercalcemia 18 years after total parathyroidectomy with auto-transplantation of parathyroid tissue to his arm.
• Laboratory tests revealed elevated parathyroid hormone (PTH) levels.
• Ultrasound of the left arm identified enlarged parathyroid tissue at the auto-transplantation site.

Findings:

• The patient was diagnosed with recurrent primary hyperparathyroidism originating from the auto-transplanted parathyroid tissue.
• A re-do parathyroidectomy of the transplanted tissue confirmed parathyroid hyperplasia.

Implications:

• This case underscores the importance of long-term, vigilant surveillance for hyperparathyroidism recurrence in MEN2A patients with parathyroid auto-transplantation.
• Even decades after initial treatment, auto-transplanted parathyroid tissue can develop hyperplasia and cause recurrent hyperparathyroidism.
• The findings emphasize the need for ongoing monitoring in patients with a history of MEN2A and parathyroid auto-transplantation.