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Recurrent primary hyperparathyroidism: A diagnostic and management dilemma

journal contribution
posted on 2023-10-13, 03:41 authored by B Wilkinson, SF Wan Muhamad Hatta, Andrew GarnhamAndrew Garnham, HN Buch
Summary Primary hyperparathyroidism requires a surgical approach to achieve a long-term cure. However, post-surgical recurrence significantly complicates the management of this condition. A number of causes for recurrent disease are well understood and several diagnostic modalities exist to localise the culprit parathyroid adenoma although none of them is efficacious in localisation of the recurrent lesion. In this case report, we highlight a novel causative mechanism and describe a unique diagnostic sequence that enabled curative treatment to be delivered. Learning points In the case described herein, we describe a novel location for a parathyroid adenoma causing recurrent PHPT. The case elucidates well the difficulties presented by such cases in terms of surgical planning and show the utility of PVS in such cases. Based on this case, we make the following recommendations: Meticulous care must be taken to prevent seeding of adenomatous tissue during primary excision. To consider the use of PVS in patients with discordant imaging in the setting of recurrent/persistent PHPT as a method to localise the causative adenoma. Same day PVS and surgery is a viable option for patients who either represent an anaesthetic risk or who are extremely anxious about the prospect of two separate procedures. Disordered calcium homeostasis is an important but forgotten cause of dysphagia which can be extremely debilitating for affected patients.

History

Journal

Endocrinology, Diabetes and Metabolism Case Reports

Volume

2021

Pagination

1-5

Location

Bristol, Eng.

ISSN

2052-0573

eISSN

2052-0573

Language

eng

Publication classification

C1.1 Refereed article in a scholarly journal

Issue

1

Publisher

BioScientifica

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