Development of primary hyperparathyroidism due to ectopic parathyroid adenoma in the upper mediastinum: a clinical case in practice

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Abstract

Background: Due to the increasing incidence of primary hyperparathyroidism (PHPT) in combination with associated complications and the potential risk of their further progression, timely screening and diagnosis of this disease are becoming an increasingly important task in real clinical practice. Early therapy of identified PHPT will prevent the development and progression of its severe complications and increase the duration and quality of life of patients.

Description of the clinical case: Patient S., 55, was followed-up for several years due to recurrent urolithiasis. In 2022, transurethral endoscopic laser fibrocalicolithotripsy was performed on the right. During an examination by an endocrinologist in 2024 regarding multinodular goiter, primary hyperparathyroidism was suspected, and therefore an examination to clarify the state of phosphorus-calcium metabolism was prescribed. During the examination, primary hyperparathyroidism and hypercalcemia were detected. According to the ultrasound examination, no formations were detected in the projection area of the parathyroid glands. In November 2024, transurethral endoscopic laser ureterolithotripsy, installation of an internal ureteral stent on the right, and percutaneous nephrolithotripsy with lithoextraction were performed. For the purpose of topical diagnostics of parathyroid adenoma, scintigraphy with three-dimensional single-photon emission computed tomography (hybrid SPECT-CT technology) of the parathyroid glands was performed, an adenoma of the ectopic right lower parathyroid gland was detected in the superior mediastinum. In January 2025, parathyroidectomy was performed. In the postoperative period, normalization of phosphorus-calcium metabolism parameters was recorded.

Conclusion: Primary hyperparathyroidism is an interdisciplinary problem, since it has quite variable clinical manifestations. Physicians of all specialties should be involved in the timely detection of PHPT.

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About the authors

G. I. Morozova

Federal Clinical Center for High Medical Technologies, Federal Medical and Biological Agency of Russia

Email: morozovagalina78@gmail.com
ORCID iD: 0009-0006-9581-3195

Cand. Sci. (Med.), Head of the Endocrinology Department

Russian Federation, Moscow Region

Valentina V. Boeva

Federal Clinical Center for High Medical Technologies, Federal Medical and Biological Agency of Russia

Author for correspondence.
Email: BoevaVV@yandex.ru
ORCID iD: 0000-0002-1964-1575

Cand. Sci. (Med.), Endocrinologist, Endocrinology Department

Russian Federation, Moscow Region

E. A. Ivaschenko

Federal Clinical Center for High Medical Technologies, Federal Medical and Biological Agency of Russia

Email: ivelen8@yandex.ru

Urologist, Urology Department with X-ray Urology Department

Russian Federation, Moscow Region

A. P. Popova

Federal Clinical Center for High Medical Technologies, Federal Medical and Biological Agency of Russia

Email: Mitua2006@yandex.ru
ORCID iD: 0009-0002-2278-3926

Surgeon, General Surgery Department

Russian Federation, Moscow Region

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2. Figure 1.Thyroid ultrasound

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3. Figure2,3. Scintigraphy with SPECT-CT of parathyroid glands

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4. Figure4. Intraoperative stage of isolation of adenoma of ectopic right lower parathyroid gland

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