Giant double parathyroid adenoma presenting as a hypercalcaemic crisis

Area of Science:

• Endocrinology
• Surgical Pathology
• Medical Case Reports

Background:

• Primary hyperparathyroidism is a common endocrine disorder often caused by a single parathyroid adenoma.
• Intrathoracic parathyroid adenomas are rare and can present diagnostic challenges.
• Hypercalcaemic crisis signifies a severe manifestation requiring urgent medical and surgical attention.

Observation:

• A patient presented with hypercalcaemic crisis and a large intrathoracic mass.
• A massive cystic parathyroid adenoma was surgically removed from the right superior mediastinum.
• A second, very large parathyroid adenoma was subsequently discovered on the contralateral side, near the left thyroid lobe.

Findings:

• This case represents the largest documented instance of a double parathyroid adenoma.
• The findings highlight the potential for significant parathyroid adenoma size and ectopic location.
• The successful management involved identifying and removing both adenomas.

Implications:

• The case underscores the necessity of a thorough cervical approach and routine bilateral neck exploration in all primary hyperparathyroidism evaluations.
• It emphasizes the importance of considering ectopic and unusually large adenomas in the differential diagnosis.
• This documentation contributes to understanding the spectrum of parathyroid disease and optimizing surgical strategies.