Acute presentation of giant parathyroid adenoma extending to the mediastinum: A case report

INTRODUCTION AND IMPORTANCE: Primary hyperparathyroidism is the most common cause of hypercalcemia in outpatients. Giant parathyroid adenomas are rare and can present diagnostic and therapeutic challenges. The clinical presentation is often insidious, and acute presentation is uncommon. CASE PRESENTATION: Herein we report a case of primary hyperthyroidism secondary to giant parathyroid adenoma in a 54-year-old woman presenting with acute and severe hypercalcemia. Preoperative laboratory exams indicated elevated values of parathormone and serum calcium. CT scan and parathyroid scintigraphy showed a giant right inferior parathyroid adenoma measuring 6 cm in its largest diameter extending to the mediastinum. Despite its size and extension, the gland was successfully managed through a transcervical parathyroidectomy. The patient is actually asymptomatic and normocalcemic after a follow up of 3 years. CLINICAL DISCUSSION: Giant parathyroid adenomas can cause severe hypercalcemia. Imaging studies are crucial for preoperative localization. A classic transcervical approach can be used to remove giant adenomas, even when they extend into the anterior mediastinum. Despite their size, giant parathyroid adenomas have a good prognosis if they are removed surgically. CONCLUSIONS: Hypercalcemia associated with a giant, functional parathyroid adenoma can be life-threatening. It is management is urgent. It is both medical and surgitforward, and various morphologiccal including correction of hypercalcemia and parathyroidectomy.