This patient had hypercalcemia, hypercalciuria, osteopenia and elevated PTH. In addition, there is a history of passing kidney stones.
Tc-99Sestamibi parathyroid scan with single photon emission computerized tomography (SPECT) shows a bright signal representing a large parathyroid adenoma posterior to the right thyroid lobe. Pre-op serum Ca was 11.4 mg/dl and iPTH 208.4 pg/ml.
A minimally invasive videoassisted parathyroidectomy was done. The right recurrent laryngeal nerve was running around the parathyroid adenoma. It was carefully dissected and the adenoma removed.
The adenoma was large(3 x 2 cm) and weighed 4200 mg. (Normal parathyroid weighs 35 mg)
Serum calcium dropped from a preoperative value of 11.4 mg/dl to 9.8 mg/dl immediately after the removal of the adenoma.
Intact PTH dropped from a preoperative value of 208.3 pg/ml to 12.3 pg/ml after the removal of the adenoma.