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Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2021

Open Access 01-12-2021 | Hyperparathyroidism | Case report

Double ipsilateral parathyroid adenomas, with one supernumerary and ectopic at the same time: a case report

Authors: Georgios Tzikos, Michael Polyzonis, Konstantinos Milias, Stefanos Milias, Ioannis Passos, Konstantinos Ioannidis, Nektaria-Dimitra Doutsini, Georgios Chatzoulis, Panagiotis Spyridopoulos

Published in: Journal of Medical Case Reports | Issue 1/2021

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Abstract

Background

Double adenomas (DA) represents a distinct clinical entity of primary hyperparathyroidism (PHPT). DA may follow various embryologic distribution patterns and could be supernumerary and/or ectopic.

Case presentation

We describe the first case of PHPT which comes as a result of double ipsilateral adenoma, of which one was both ectopic and supernumerary. A 45 year-old Greek male patient with diagnosed PHPT due to a single lower right parathyroid adenoma was admitted to our department for surgical treatment. The preoperative tests (neck US, Sestamibi scan) were conclusive for single gland disease. The patient underwent focused parathyroidectomy. The frozen section revealed a parathyroid adenoma with a slight possibility for parathyroid carcinoma. Ten minutes after the excision, intact PTH (iPTH) dropped >50% related to preoperative values and was within normal range. Right hemithyroidectomy with additional ipsilateral central neck dissection was performed, because of the possibility for parathyroid carcinoma. The final pathology report showed that the first excised tissue proved to be a parathyroid adenoma, while a second subcapsular one and a normal right upper parathyroid gland were also found.

Conclusions

Preoperative localization of DA using routine imaging tests and the utility of intraoperative parathyroid hormone assay are still unreliable in detecting multiple adenomas. Furthermore, a slight possibility of a second and simultaneously supernumerary and ectopic adenoma maybe present. Therefore, it would be advisable to establish the use of more advanced imaging tests (such as 4D-CT, 4D-MRI) or other diagnostic tools when DA are suspected.
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Metadata
Title
Double ipsilateral parathyroid adenomas, with one supernumerary and ectopic at the same time: a case report
Authors
Georgios Tzikos
Michael Polyzonis
Konstantinos Milias
Stefanos Milias
Ioannis Passos
Konstantinos Ioannidis
Nektaria-Dimitra Doutsini
Georgios Chatzoulis
Panagiotis Spyridopoulos
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2021
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-021-02711-x

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