Category: Calcium/Bone Disorders

Monitor: 14

14 - Case of Recurrent Hyperparathyroidism secondary to ectopic parathyroid tissue requiring multiple surgeries

Saturday, Apr 27
10:00 AM – 10:30 AM

Objective : We present a case of hyperparathyroidism secondary to ectopic parathyroid tissue. Hypercalcemia persisted despite initial surgery with parathyroid gland removal, and further surgery with mediastinal exploration and removal of ectopic parathyroid tissue was necessary. 


Methods : N/A


Results : N/A


Discussion :

53 year old female with history of osteopenia, nephrolithiasis, presented with hypercalcemia. Workup showed increased 24 hr urine collection, and elevated parathyroid hormone levels. Calcium was in the range of 10.7mg/dL to 11.9mg/dL. Parathyroid hormone level ranged from 178pg/mL to 245 pg/mL. She initially had right thyroid lobectomy, with pathology showing papillary microcarcinoma and right parathyroidectomy, however there was no change in PTH intraoperatively or post operatively. Sestamibi scan a few months after surgery continued to show increased uptake in the anterior mediastinum, representing a possible area of ectopic parathyroid adenoma. CT scan post surgery showed an 8mm anterior mediastinal mass. She then had repeat surgery with thymectomy and removal of residual ectopic parathyroid tissue. Pathology confirmed parathyroid gland tissue with cystic changes in the anterior neck mass and hyperplastic parathyroid tissue in the thymus. Subsequently, PTH levels decreased and Ca also improved. 


Ectopic parathyroid tissue can be an uncommon etiology of persistent hyperparathyroidism. Most frequent locations are in the anterior mediastinum, thymus. They can also occur in the tracheoesophageal groove and retroesophageal region. They can pose a surgical dilemma during the workup of hyperparathyroidism and can be missed initially. Some cases of ectopic parathyroid tissue require multiple surgical explorations. 


Conclusion : This case highlights the rare etiology of ectopic parathyroid tissue as the cause of persistent hypercalcemia. Ectopic parathyroid tissue should always be considered in the differential during the evaluation of hyperparathyroidism, and can be missed upon initial diagnosis. 

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Priyanka Bikkina

Fellow
University of Florida Jacksonville
Jacksonville, Florida

University of Michigan B.S Completion in 2009. American University of Antigua MD completion in 2014. 2006-2008: Research assistant, Department of Pathology at University of Michigan. 2008-2009: Research assistant, The Molecular and Behavioral Neuroscience Institute, University of Michigan. 2009- Research assistant , Department of psychology at University of Michigan. Dean's Grant for study of Effect of Vitamin D Deficiency on ER/Oxidative stress in Type 2 Diabetes: Inhibition by statins.

Marilu Jurado-Flores

Assistant Professor
University of Florida Jacksonville

Medical Education: Catholic University of Santiago De Guayaquil, Guayas, Ecuadar
Residency: Internal Medicine, University of Miami Hospital and Clinics, Miami, FL, USA
Fellowship: Endocrinology, Diabetes and Metabolism, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA

Krista Gonzales

Endocrinology Fellow
University of Florida College of Medicine - Jacksonville

M.D., Ross University School of Medicine, Completion 2012
2013-2016 Internal Medicine Residency, Memorial Health University Medical Center (Savannah, Georgia)
2016-2018 Endocrinology Fellowship, University of Florida College of Medicine – Jacksonville (Jacksonville, Florida)

Priyanka Bikkina

Fellow Physician
University of Florida Jacksonville

University of Michigan B.S Completion in 2009. American University of Antigua MD completion in 2014. 2006-2008: Research assistant, Department of Pathology at University of Michigan. 2008-2009: Research assistant, The Molecular and Behavioral Neuroscience Institute, University of Michigan. 2009- Research assistant , Department of psychology at University of Michigan