A report of two cases of parathyroid adenoma with associated chronic lymphocytic parathyroiditis

Parathyroid adenomas with chronic parathyroiditis are challenging to diagnose, as the etiology is unknown and may lie on a spectrum from systemic autoimmune changes to local inflammatory reactions. We aim to present 2 cases of hypercellular parathyroid glands with chronic lymphocytic parathyroiditis and review all other cases reported in the literature. Overall, the clinical course was benign, and surgical intervention was warranted due to the symptomatic nature of the presentations. The surgery was carried out without complications, leading to immediate and significant improvement in the patients' symptoms, normalization of calcium and parathyroid hormone levels, and a mild improvement in glomerular filtration rate. The pathological examination of the surgical specimens revealed hypercellular parathyroid glands with scattered foci of lymphocytic parathyroiditis and lymphocytic aggregates in both cases, alongside germinal center formation in 1 of the cases. This atypical presentation may warrant consideration of an autoimmune evaluation, which could impact post-operative surveillance. Furthermore, patients may benefit from referral to rheumatology and endocrinology, as well as surveillance for other autoimmune endocrinopathies.