An Uncommon Presentation Severe Hypercalcemia Linked to Cystic Parathyroid Adenoma Despite Negative Sestamibi Scan: A Case Report

Cystic parathyroid adenomas are uncommon occurrences, constituting approximately 1-2%, of primary hyperparathyroidism cases. They frequently pose diagnostic difficulties due to their limited detection in sestamibi scans. These cases of primary hyperparathyroidism commonly manifest with hypercalcemi...

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Main Authors: Smriti Acharya, Sharon Daniel, Suyash Acharya, Rajinder Gupta, Daniel Kannappan
Format: Article
Language:English
Published: Nepal Medical Association 2025-07-01
Series:Journal of Nepal Medical Association
Subjects:
Online Access:https://www.jnma.com.np/jnma/index.php/jnma/article/view/9170
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author Smriti Acharya
Sharon Daniel
Suyash Acharya
Rajinder Gupta
Daniel Kannappan
author_facet Smriti Acharya
Sharon Daniel
Suyash Acharya
Rajinder Gupta
Daniel Kannappan
author_sort Smriti Acharya
collection DOAJ
description Cystic parathyroid adenomas are uncommon occurrences, constituting approximately 1-2%, of primary hyperparathyroidism cases. They frequently pose diagnostic difficulties due to their limited detection in sestamibi scans. These cases of primary hyperparathyroidism commonly manifest with hypercalcemic crisis despite negative scan results. I present a rare scenario involving an elderly male who arrived at the emergency department with a swollen left neck, primarily due to a thyroid cyst causing breathing difficulties. Incidentally, hypercalcemia was also discovered during examination. Thorough investigations ensued, leading to the decision to perform a right hemithyroidectomy to address the large thyroid cyst and a parathyroidectomy. Histopathological analysis confirmed the presence of a cystic parathyroid adenoma, with subsequent normalization of calcium levels. Following the procedures, the patient experienced hypocalcemia and required calcium supplementation. This case stands out due to the high levels of parathyroid hormone, which typically raises suspicion for parathyroid carcinoma, making it a unique diagnostic challenge.
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series Journal of Nepal Medical Association
spelling doaj-art-c1e561d78ded4ad89ec91defcefe953c2025-08-20T04:02:28ZengNepal Medical AssociationJournal of Nepal Medical Association0028-27151815-672X2025-07-016328810.31729/jnma.9170An Uncommon Presentation Severe Hypercalcemia Linked to Cystic Parathyroid Adenoma Despite Negative Sestamibi Scan: A Case ReportSmriti Acharya0Sharon Daniel1Suyash Acharya2Rajinder Gupta3Daniel Kannappan4Registrar, Diabetes and Endocrinology, WWL NHS Foundation Trust, Wigan, United KingdomJunior clinical fellow, Diabetes and Endocrinology, WWL NHS Foundation Trust, Wigan , United KingdomJunior clinical fellow, Diabetes and Endocrinology, WWL NHS Foundation Trust, Wigan , United KingdomConsultant, Diabetes and Endocrinology, WWL NHS Foundation Trust, Wigan, United KingdomConsultant, Diabetes and Endocrinology, WWL NHS Foundation Trust, Wigan, United Kingdom Cystic parathyroid adenomas are uncommon occurrences, constituting approximately 1-2%, of primary hyperparathyroidism cases. They frequently pose diagnostic difficulties due to their limited detection in sestamibi scans. These cases of primary hyperparathyroidism commonly manifest with hypercalcemic crisis despite negative scan results. I present a rare scenario involving an elderly male who arrived at the emergency department with a swollen left neck, primarily due to a thyroid cyst causing breathing difficulties. Incidentally, hypercalcemia was also discovered during examination. Thorough investigations ensued, leading to the decision to perform a right hemithyroidectomy to address the large thyroid cyst and a parathyroidectomy. Histopathological analysis confirmed the presence of a cystic parathyroid adenoma, with subsequent normalization of calcium levels. Following the procedures, the patient experienced hypocalcemia and required calcium supplementation. This case stands out due to the high levels of parathyroid hormone, which typically raises suspicion for parathyroid carcinoma, making it a unique diagnostic challenge. https://www.jnma.com.np/jnma/index.php/jnma/article/view/9170adenomahypercalcemiahyperparathyroidismparathyroid
spellingShingle Smriti Acharya
Sharon Daniel
Suyash Acharya
Rajinder Gupta
Daniel Kannappan
An Uncommon Presentation Severe Hypercalcemia Linked to Cystic Parathyroid Adenoma Despite Negative Sestamibi Scan: A Case Report
Journal of Nepal Medical Association
adenoma
hypercalcemia
hyperparathyroidism
parathyroid
title An Uncommon Presentation Severe Hypercalcemia Linked to Cystic Parathyroid Adenoma Despite Negative Sestamibi Scan: A Case Report
title_full An Uncommon Presentation Severe Hypercalcemia Linked to Cystic Parathyroid Adenoma Despite Negative Sestamibi Scan: A Case Report
title_fullStr An Uncommon Presentation Severe Hypercalcemia Linked to Cystic Parathyroid Adenoma Despite Negative Sestamibi Scan: A Case Report
title_full_unstemmed An Uncommon Presentation Severe Hypercalcemia Linked to Cystic Parathyroid Adenoma Despite Negative Sestamibi Scan: A Case Report
title_short An Uncommon Presentation Severe Hypercalcemia Linked to Cystic Parathyroid Adenoma Despite Negative Sestamibi Scan: A Case Report
title_sort uncommon presentation severe hypercalcemia linked to cystic parathyroid adenoma despite negative sestamibi scan a case report
topic adenoma
hypercalcemia
hyperparathyroidism
parathyroid
url https://www.jnma.com.np/jnma/index.php/jnma/article/view/9170
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