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<p>Primary hyperparathyroidism (PHPT) is often identified incidentally through routine biochemical tests in otherwise asymptomatic individuals. However, in nutritionally vulnerable or resource-constrained settings, it can present with striking systemic symptoms that resemble unrelated conditions. This case series highlights the varied clinical faces of PHPT and the importance of recognizing biochemical patterns even when imaging or clinical signs are not typical. To analyze the clinical variability, diagnostic pathways, and surgical outcomes in four female patients with biochemically confirmed parathyroid adenoma, each presenting with an atypical or misleading clinical picture. A prospective case series of four female patients (ages 34–61) with biochemically confirmed PHPT managed surgically at a tertiary center. Clinical, radiological, intraoperative, and histopathological findings were analyzed. Presentations included- recurrent pancreatitis in a severely underweight patient, bilateral parathyroid adenomas with dyspnea, vocal cord palsy due to an impinging thyroid nodule with concurrent parathyroid adenoma, and hip fractures with incidental papillary thyroid carcinoma. All underwent parathyroidectomy, with one requiring total thyroidectomy. This series reflects the evolving face of PHPT in undernourished patients marked by systemic complications, radiological surprises, and co-existing thyroid pathology. Surgical identification was aided by intraoperative PTH monitoring, the saline floatation test, and histopathology. Parathyroid adenomas may wear many clinical masks, particularly in nutritionally compromised and chronically ill patients. A high index of suspicion, multidisciplinary collaboration, and surgical precision remain pivotal to successful outcomes. These four cases not only expand the phenotype of PHPT but also reinforce the continued relevance of individualized surgical judgment in endocrine neck surgery.</p>

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From Stones to Bones to Groans: A Case Series on the Varied Presentation of Parathyroid Adenoma

  • 期刊论文

  • 发表日期：

    2026年3月13日

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  • Kiran Kumar Prathipati,
  • K Khadeeja,
  • Sanskriti Jaiswal,
  • Rohit Bhondekar

摘要

Primary hyperparathyroidism (PHPT) is often identified incidentally through routine biochemical tests in otherwise asymptomatic individuals. However, in nutritionally vulnerable or resource-constrained settings, it can present with striking systemic symptoms that resemble unrelated conditions. This case series highlights the varied clinical faces of PHPT and the importance of recognizing biochemical patterns even when imaging or clinical signs are not typical. To analyze the clinical variability, diagnostic pathways, and surgical outcomes in four female patients with biochemically confirmed parathyroid adenoma, each presenting with an atypical or misleading clinical picture. A prospective case series of four female patients (ages 34–61) with biochemically confirmed PHPT managed surgically at a tertiary center. Clinical, radiological, intraoperative, and histopathological findings were analyzed. Presentations included- recurrent pancreatitis in a severely underweight patient, bilateral parathyroid adenomas with dyspnea, vocal cord palsy due to an impinging thyroid nodule with concurrent parathyroid adenoma, and hip fractures with incidental papillary thyroid carcinoma. All underwent parathyroidectomy, with one requiring total thyroidectomy. This series reflects the evolving face of PHPT in undernourished patients marked by systemic complications, radiological surprises, and co-existing thyroid pathology. Surgical identification was aided by intraoperative PTH monitoring, the saline floatation test, and histopathology. Parathyroid adenomas may wear many clinical masks, particularly in nutritionally compromised and chronically ill patients. A high index of suspicion, multidisciplinary collaboration, and surgical precision remain pivotal to successful outcomes. These four cases not only expand the phenotype of PHPT but also reinforce the continued relevance of individualized surgical judgment in endocrine neck surgery.