An Asymptomatic Primary Hyperparathyroidism Case Due to a Mediastinum Localized Ectopic Giant Parathyroid Adenoma

ABSTRACT

The majority of primary hyperparathyroidism is caused by a parathyroid adenoma adjacent to the thyroid gland. Parathyroid adenomas rarely originate from an ectopic parathyroid gland and develop as a result of embryological migration defect. Even though asymptomatic hypercalcemia is the most frequent presentation of primary hyperparathyroidism, the possibility of being symptomatic increases in the case when the size of adenoma enlarges. Herein, we present a case of a 65-year-old man who was incidentally detected with hypercalcemia during his routine examination in our department. An increased MIBI uptake was observed at the anterior mediastinum in parathyroid scintigraphy. The adenoma measured 9x5x3 cm in size and weighed 83 g, which was excised successfully via video-assisted thoracoscopy. The histopathological examination confirmed the diagnosis of parathyroid adenoma. After a trouble-free recovery period, the patient showed normocalcemia and normal parathyroid hormone levels in the postoperative first year. We usually encounter with higher calcium levels and significant clinical symptoms in patients with larger parathyroid adenomas. However, the present case of exceptional giant mediastinal parathyroid adenoma showed no clinical symptoms or significant organ damage due to hypercalcemia.