Beyond the Thyroid Bed: A Rare Case of Vagal Parathyroid Adenoma Causing Primary Hyperparathyroidism

Primary hyperparathyroidism (PHPT) is a significant endocrine disorder characterized by excessive secretion of parathyroid hormone (PTH), leading to hypercalcemia. It is intriguing how the majority of cases are attributed to solitary hyperfunctioning parathyroid adenomas, while a smaller fraction involves multiglandular disease or rarely parathyroid carcinoma. Ectopic parathyroid adenomas, though less common, pose a considerable challenge in diagnosis and surgical management due to their aberrant location. It is crucial to consider the possibility of multiglandular disease or ectopic glands when preoperative localization fails or when repeat surgery is necessary. Moreover, the mention of intravagal parathyroid adenomas emphasizes the need for vigilance in considering rare ectopic locations during both diagnosis and surgical intervention. These cases underscore the importance of continuous advancements in imaging modalities such as four-dimensional computed tomography scans or 18 F Choline Pet CT to enhance localization and visualization, ultimately improving surgical outcomes. Overall, these clinical vignettes shed light on the diverse presentations and challenges in managing PHPT, emphasizing the importance of a multidisciplinary approach integrating clinical, radiological, and surgical expertise to optimize patient care. We describe a patient with persistent primary hyperparathyroidism who underwent one unsuccessful surgical procedure due to an intravagal parathyroid adenoma.