Metachronous parathyroid adenoma characterised by recurrent nephrolithiasis

Area of Science:

• Endocrinology
• Nephrology
• Surgical Pathology

Background:

• Hyperparathyroidism, often asymptomatic, can present with severe symptoms like nephrolithiasis and bone pain.
• Metachronous parathyroid adenomas, though rare, can cause recurrent hyperparathyroidism years after initial diagnosis and treatment.

Purpose of the Study:

• To report a case of recurrent primary hyperparathyroidism due to a metachronous parathyroid adenoma.
• To emphasize the significance of evaluating nephrolithiasis for underlying hyperparathyroidism.
• To discuss the diagnostic and clinical implications of metachronous parathyroid adenomas.

Main Methods:

• Case report of a woman in her 60s with a history of parathyroid adenoma.
• Clinical presentation of recurrent nephrolithiasis, urinary tract infections, and bacteremia.
• Surgical neck exploration and removal of a metachronous parathyroid adenoma.

Main Results:

• The patient presented with recurrent nephrolithiasis and symptoms consistent with recurrent primary hyperparathyroidism.
• A metachronous parathyroid adenoma was identified and surgically removed.
• Complete resolution of symptoms was achieved post-operatively.

Conclusions:

• Nephrolithiasis warrants evaluation for hyperparathyroidism, even in patients with a prior history of parathyroid disease.
• Metachronous parathyroid adenomas are an uncommon but important cause of recurrent hyperparathyroidism.
• Effective communication of laboratory results and patient follow-up are crucial in managing hyperparathyroidism.