Q: What is the diagnosis?
Bilateral 4-gland exploration revealed a right superior parathyroid adenoma at the lower paratracheal area. (Fig.2). Histology confirmed the presence of an encapsulated, 10gr/4.5X2.3 cm, parathyroid adenoma. A peripheral rim of normal glandular tissue was identified.
Primary hyperparathyroidism is the most common cause of hypercalcemia in the adult population. The diagnosis is biochemical and entails an inappropriately high PTH level despite high-normal/high Ca++ serum level. Secondary causes of PTH elevation should be ruled out. Imaging studies does not aid in the diagnosis and are not used for selecting patients for surgical referral [1]. Even though various minimally invasive techniques do exist, open bilateral 4-gland exploration is the preferred operative strategy in cases with discordant or negative preoperative localization studies [1,2].