A rare case of giant parathyroid adenoma presenting with recurrent episodes of pancreatitis

Abstract

Parathyroid adenomas are usually small in size; (weighing 70 mg–1 g) those weighing more than 2–3 g are classified as giant parathyroid adenomas. Giant parathyroid adenomas are in fact rarely encountered among patients with primary hyperparathyroidism. They are believed to have distinct clinical and biochemical features related to specific genomic alterations. We chanced to manage a unique and possibly the first case of giant parathyroid adenoma (6 cm diameter and weighing 20 g) presenting with recurrent episodes of pancreatitis and discuss its surgical management with an added emphasis on the role of nuclear imaging in its preoperative localization. Our case demonstrates that clinicians should have a high index of suspicion of primary hyperparathyroidism in patients presenting with recurrent episodes of pancreatitis. Timely diagnosis, appropriate preoperative localization techniques, which would include a parathyroid scintigraphy and a focused surgical intervention are crucial to resolve complications and improve outcomes.

Giant Parathroid Adenoma With Thoracic Extension: A Case Report

“…6 Krishnamurthy reported the same circumstance of discovery in a patient presenting recurrent episodes of acute pancreatitis. 4 Blood tests showed, in our case, hypercalcemia with high level of PTH confirming the diagnosis of a primary hyperparathyroidism. Normocalcemic hyperparathyroidism can also be seen and should not be confused with secondary hyperparathyroidism.…”

“…2 Over the years, the clinical presentation of primary hyperparathyroidism has changed from a severe disease to a disease with subtle symptoms and physiologic perturbations. 4 The examination of the cervical region is usually with no particularities. The elevated levels of serum calcium is at the origin of skeletal, renal, gastrointestinal, cardiac, and neurological symptoms.…”

“…The incorporation of single-photon emission computed tomography-computed tomography (SPECT-CT) as a component of hybrid imaging enables a high spatial resolution three-dimensional (3D) image. 4,7 In the ultrasounds, parathyroid adenoma appears as hypoechoic mass with smooth borders and homogeneous echogenicity. 9 However, this modality used alone, especially in giant adenomas, can underestimate the size as only a part of the adenoma may be visualised transcervically.…”

A Case of Hyperparathyroidism due to a Large Intrathyroid Parathyroid Adenoma with Recurrent Episodes of Acute Pancreatitis

“…Generally, most parathyroid adenomas remain relatively small, measuring under a few centimeters and weighing less than 1 g [ 3 ]. Large or giant parathyroid adenomas are seldom seen in patients with PHPT [ 4 ], and in such cases differential diagnosis is necessary to rule out malignancy.…”

The diagnostic and therapeutic challenges in the management of a double giant parathyroid adenoma

“…[ 1 ] Double parathyroid adenomas have been reported to very rarely occur. [ 2 ] We possibly report the second case in the literature of primary hyperparathyroidism caused by double giant parathyroid adenoma,[ 3 ] presenting with severe symptomatic hypercalcemia and discuss the diagnostic and therapeutic challenges in its management.…”