Acute hyperparathyroid crisis: ectopic submandibular parathyroid gland the culprit

Abstract

Parathyroid exploration via a focused approach or bilateral neck exploration should be considered in the management of all types of hyperparathyroidism. Eutopic and ectopic, single or multiple glands can pose challenges to the surgeon and available preoperative imaging modalities may not be equally applicable or appropriate in all cases. We report an interesting case of parathyroid surgery where the patient presented with a rare ectopic adenoma in the form of a hyperparathyroid crisis.

Severe hypercalcemia secondary to parathyroid adenoma: Series of four consecutive cases at a tertiary care hospital in Qatar

“…On the other hand, one of our cases reported abdominal pain, where abdominal pain could be present in 48 % of patients with hypercalcemia [ 19 ]. We also observed history of renal stones in one case, where stones are frequently encountered in hypercalcemia secondary to a PA among 8.3 %–24 % of patients [ 1 , 17 ], causing repeated admissions for renal lithiasis, ureterolithotomy for obstructive calculus and secondary hydronephrosis, or renal failure [ 20 , 23 ]. Certainly, research suggests that kidney stones are a critical factor that independently forecasts hypercalcemic patients at high risk of HC [ 19 ].…”

“…Our patients revealed severely high Ca levels and elevated intact PTH, consistent with the literature. In HC due to PHPT, patients have profound hypercalcemia [serum ≥3.5 mmol/L] [ 25 ]; and some cases had severely elevated total serum Ca of 5.74 mmol/L and high iPTH [ 23 ]. Certainly, across 37 hyperparathyroid-induced HC cases, high mean serum Ca and iPTH were evident (3.77 ± 0.26 mmol/L and 890.33 ± 163.7 pg/mL respectively) [ 17 ].…”

“…Our patients undertook US thyroid and parathyroid that suggested PA; and parathyroid SPECT/CT scans after 643 MBq Tc 99 m sestamibi injection were highly suspicious of autonomous functioning parathyroid tissue. Others reported that high-frequency ultrasound and non-contrast CT (contrast study was avoided due to elevated serum creatinine) showed a swelling behind the lower pole of thyroid right lobe [ 23 ]. A point to note is that some reports suggest that sestamibi scintigraphy becomes more accurate as gland size increases [ 26 ]; and conversely, the MIBI scan's sensitivity is decreased in cases with lower levels of preoperative serum PTH, particularly important in adenomas with cystic components [ 27 ].…”