Endocrine Abstracts

Introduction and importance: Primary hyperparathyroidism is a prevalent source of hypercalcemia, predominantly attributed to a solitary adenoma in 80-85% of cases. Progress in imaging techniques has enhanced the accurate preoperative identification and targeted removal of hyperfunctional parathyroids in primary hyperparathyroidism (PHPT). The amalgamation of imaging methods or a "dual" approach, when congruent, enhances the precision of adenoma localization. Surgery remains the sole curative intervention for pHPT. The surgical approach must be carefully chosen to ensure optimal cure while minimizing dissection and associated morbidity.

Case presentation: We report the case of a 62-year-old female with a history of well-controlled hypertension on dual therapy and a history of cholecystectomy. She was admitted for the management of primary hyperparathyroidism, biochemically confirmed with a corrected calcium level of 110 mg/l, a phosphorus level of 22 mg/l, a PTH level 3.7 times the normal range, and elevated 24-hour urine calcium. As part of the impact assessment, we identified osteoporosis. In the localization assessment, cervical ultrasound revealed a right parathyroid adenoma with a distinctive aspect involving the carotid artery. Initially, we conducted a MIBI scintigraphy, which did not reveal any abnormalities, followed by a cervicothoracic CT scan that did not show evidence of a parathyroid adenoma. In situ echoguided PTH measurement returned high at 1 335 000 pg/ml. A PET scan with F-choline was performed, confirming a parathyroid adenoma adjacent to the lower pole of the right thyroid lobe. Additionally, an angioscan was conducted for a more comprehensive characterization of the carotid artery, indicating a right common carotid dolichoartery.

Conclusion: Surgery stands as the optimal course of treatment for our patient; nevertheless, the presence of this vascular malformation requires a thorough evaluation of the risk-benefit profile to recommend a suitable therapeutic strategy. Our patient’s case will undergo review in a multidisciplinary team meeting to formulate an optimal management plan.