Descended right superior parathyroid adenoma mimicking as inferior adenoma in primary hyperparathyroidism

Description

A 22-year-old woman presented with generalised bony pains over past 2 years. Clinical examination was unremarkable, and blood biochemistry revealed parathyroid hormone (PTH)-dependent hypercalcaemia, suggestive of primary hyperparathyroidism (albumin-corrected calcium –11 mg/dL (normal range 8.3–10.4); PTH –256 pg/mL (normal range 8–50)). Her creatinine was 0.8 mg/dL (normal range 0.6–1.2) and 25-OH vitamin D level was 31 ng/mL (30–75). She had low bone mass at distal end of radius (Z score of –2.8) and there was no evidence of renal stones. On localisation, both parathyroid scinitigraphy and ultrasound of neck localised the lesion to right inferior gland (figure 1A,B). There were no features of multiple endocrine neoplasia type 1.

Figure 1

(A)Parathyroid scintigraphy displaying an adenoma at right side. (B) Ultrasound neck showing right-sided adenoma.

She underwent focused right inferior parathyroidectomy, without intraoperative PTH (IOPTH) assay. Postoperatively,however, she had persistent hyperparathyroidism, and biopsy from the excised lesion revealed...

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