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Recurrent primary hyperparathyroidism : A diagnostic and management dilemma
Wilkinson, Ben Wan Muhamad Hatta, Sharifah Faradila Garnham, Andrew Peter Buch, Harit N.
Wilkinson, Ben
Wan Muhamad Hatta, Sharifah Faradila
Garnham, Andrew Peter
Buch, Harit N.
Abstract
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.
Keywords
Adult, Male, White, United Kingdom, Parathyroid, Mineral, Radiology, Rheumatology, Surgery
Date
2021
Type
Journal article
Journal
Book
Volume
2021
Issue
1
Page Range
1-5
Article Number
ACU Department
Centre for Exercise and Nutrition
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Event URL
Open Access Status
License
CC BY-NC-ND 4.0
File Access
Open
Notes
© 2021 The authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.