Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in an uncommon location: a case report

Abstract

Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum is a rare clinical condition. We present a 75-year-old male with primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum. This patient was initially referred to the clinic for suspected incidental hypercalcemia. Initial imaging showed two suspicious lesions: one adjacent to the thyroid gland and another in the mediastinum. Further investigations identified a sole mediastinal adenoma. The diagnosis was confirmed by normalization of parathyroid hormone levels after its surgical resection. Thoroughly diagnosing such cases can prove challenging and using a single modality such as ultrasonography, computed tomography, or nuclear imaging alone may not yield conclusive findings or can give false positive results. Our case demonstrates that a combination of several imaging modalities can lead to accurate localization of the cause of primary hyperparathyroidism. This will obviate the performance of unnecessary surgical procedures. In addition, the possibility of missing additional sources of ectopic secretions of the parathyroid hormone will be reduced.

The Mediastinal Parathyroid-peeping through the Window

“…Parathyroid adenomas are the most common cause of primary hyperparathyroidism (PHPT). In 6-16% cases these are ectopically located, and of these, 20% may be located in the mediastinum 1,2 The common etiology for ectopic locations of parathyroid is due to comigration along with other tissues with the same embryological origin. 3,4 These glands may also be supernumerary in up to 22% of cases with other parathyroids in their normal locations and are a major cause of failed parathyroid operations.…”

Ectopic parathyroid adenoma in a patient with multiple endocrine tumours

“…Therefore, the patient underwent a combined surgery that included total thyroidectomy and excision of both the paraesophageal lesion and the pulmonary nodule. A right inferior parathyroid gland was also removed due to its abnormal appearance in the intraoperative examination; however, PTH Ectopic parathyroid adenomas (EPA) are a relatively common cause of primary hyperparathyroidism (PHPT), occurring with an incidence of up to 25% [1]. Ectopic parathyroid glands may arise from abnormal migration during embryogenesis, or they can be acquired, due to the influence of gravity in an enlarged parathyroid gland [2].…”