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Case Reports in Medicine
Volume 2010 (2010), Article ID 596185, 4 pages
http://dx.doi.org/10.1155/2010/596185
Case Report

A Parathyroid Adenoma: Benign Disease Presenting with Hyperparathyroid Crisis

Department of General Surgery, Princess Royal University Hospital, Farnborough Common, Orpington, Kent BR6 8ND, UK

Received 2 October 2010; Revised 29 November 2010; Accepted 6 December 2010

Academic Editor: Chung Yau Lo

Copyright © 2010 A. S. Tahim et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hyperparathyroid crisis is a rare manifestation of parathyroid disease. We present the case of a 53-year-old gentleman with a review of the current literature. He presented in acute renal failure with epigastric pain and vomiting. His serum-corrected calcium (CCa2+) was raised at 5.2 mmol/L, in addition to a massively raised parathyroid hormone (PTH) level (3957 ng/L). Ultrasound studies of the neck revealed a 2 cm well-defined mass inferoposterior to right thyroid lobe. CT scans of the neck showed a normal mediastinum and confirmed no associated lymphadenopathy. Having undergone medical resuscitation for 9 days, a neck exploration revealed a cystic mass, which was excised. Histological investigations revealed a 9.25 g, cystic parathyroid adenoma with no features of malignancy. His PTH and CCa2+ returned to normal postoperatively. This suspicious presentation of benign disease, including a marked elevation in PTH, highlights the challenges facing the endocrine surgeon in dealing with parathyroid disease.