Exceedingly Hyper-Secreting Parathyroid Adenoma: A Literature Review and Case Series

Area of Science:

• Endocrinology
• Oncology

Background:

• Hypercalcemia is commonly caused by hyperparathyroidism, often due to parathyroid adenoma or carcinoma.
• Differentiating between adenoma and carcinoma can be difficult with severely elevated serum calcium and parathyroid hormone (PTH) levels.
• Parathyroid carcinomas typically present with significantly higher values and more severe symptoms.

Purpose of the Study:

• To highlight the diagnostic challenges in distinguishing parathyroid adenoma from carcinoma.
• To present cases of parathyroid adenoma mimicking carcinoma due to markedly elevated PTH levels.

Main Methods:

• Retrospective chart review of patient data.
• Literature review to assess existing research.

Main Results:

• Three female patients with symptomatic hypercalcemia and markedly elevated PTH levels (755-3547.4 pg/mL) underwent successful parathyroid adenoma excision.
• No histopathologic evidence of malignancy was found in the excised tissues.
• Patients experienced normalization of calcium levels postoperatively with an intraoperative reduction in PTH levels.
• A scarcity of literature exists regarding similar presentations.

Conclusions:

• Exceptional cases of parathyroid adenoma with markedly elevated PTH levels underscore the importance of considering diverse presentations.
• These findings serve as a reminder to clinicians regarding the varied clinical and laboratory manifestations of parathyroid adenomas, even when mimicking malignancy.