Recurrent Primary Hyperparathyroidism due to Multiglandular Parathyroid Hyperplasia: A Case Report.

Nur Aziah Binti Adib Anuar

doi:10.63363/aijfr.2025.v06i06.2081

Recurrent Primary Hyperparathyroidism due to Multiglandular Parathyroid Hyperplasia: A Case Report.

Author(s)	Dr. Nur Aziah Binti Adib Anuar
Country	Malaysia
Abstract	Background: Primary hyperparathyroidism (PHPT) is commonly caused by a single parathyroid adenoma; however, multiglandular disease (MGD) remains an important differential, especially in recurrent or persistent cases. This case illustrates recurrent PHPT due to parathyroid hyperplasia involving all four glands, mimicking a solitary adenoma initially. Case Presentation: A 60-year-old woman presented in 2022 with a right ureteric calculus and was incidentally found to have asymptomatic hypercalcemia (peak corrected calcium 2.98 mmol/L). Further workup revealed elevated serum intact parathyroid hormone (iPTH) at 17.72 pmol/L, normal phosphate, and renal function. Sestamibi scan showed persistent tracer uptake in the mid-left thyroid region, suggestive of an intrathyroidal parathyroid adenoma. She underwent left parathyroidectomy, with intraoperative findings of bilateral left gland enlargement. Histopathology confirmed parathyroid hyperplasia. Despite initial improvement, she had biochemical recurrence within 6 months, with serum calcium of 3.02 mmol/L and iPTH of 14 pmol/L. Neck ultrasound revealed a right inferior parathyroid lesion. She underwent right parathyroidectomy in February 2025. Intraoperative findings revealed an enlarged right superior gland (1.5 cm) and a small right inferior gland (5 mm), the latter of which was partially autotransplanted into the right sternocleidomastoid muscle. Intraoperative PTH monitoring showed a >50% drop post-excision, satisfying the Miami criterion. Histopathology again confirmed parathyroid hyperplasia. Postoperative recovery was uneventful. She was discharged on calcium carbonate and calcitriol supplementation. At 6-week follow-up, serum calcium normalized (2.5 mmol/L) with suppressed iPTH (0.58 pmol/L). Conclusion: This case emphasises the diagnostic challenges of MGD in PHPT. Although Sestamibi may localise a dominant lesion, underlying multiglandular hyperplasia must be considered, especially in recurrent disease. Surgical management with subtotal parathyroidectomy and auto transplantation is effective in such cases.
Keywords	Recurrent parathyroid adenoma,Multiglandular disease.
Field	Medical / Pharmacy
Published In	Volume 6, Issue 6, November-December 2025
Published On	2025-11-18
DOI	https://doi.org/10.63363/aijfr.2025.v06i06.2081
Short DOI	https://doi.org/hbbz7r

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Recurrent Primary Hyperparathyroidism due to Multiglandular Parathyroid Hyperplasia: A Case Report.

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