Primary Hyperparathyroidism From Concurrent Parathyroid Hyperplasia and Ectopic Parathyroid Adenoma: A Case Report

Area of Science:

• Endocrinology
• Surgical Pathology
• Medical Diagnostics

Background:

• Primary hyperparathyroidism (PHPT) is often curable with parathyroidectomy.
• Persistent elevation of parathyroid hormone (PTH) post-surgery suggests multiglandular involvement.
• Diagnostic imaging can be negative despite active parathyroid disease.

Purpose of the Study:

• To report a rare case of concurrent single-gland parathyroid hyperplasia and ectopic parathyroid adenoma.
• To illustrate the diagnostic challenges in persistent PHPT despite negative imaging.
• To underscore the importance of considering ectopic parathyroid tissue in refractory cases.

Main Methods:

• Case presentation of a 72-year-old woman with long-standing PHPT.
• Review of diagnostic imaging and biochemical parameters (calcium, PTH).
• Surgical intervention including initial parathyroidectomy and subsequent resection of ectopic adenoma.

Main Results:

• Initial parathyroidectomy for hyperplasia did not resolve elevated PTH and calcium.
• An ectopic paraesophageal parathyroid adenoma was subsequently identified and resected.
• Successful resolution of PHPT after removal of the ectopic adenoma.

Conclusions:

• Negative imaging does not exclude active parathyroid disease in PHPT.
• Ectopic parathyroid adenomas can cause persistent PHPT even after apparent multigland disease treatment.
• A high index of suspicion and thorough investigation are crucial for refractory PHPT.