Navigating Diagnostic Challenges in Ectopic Parathyroid Adenomas: A Case Report

Ectopic parathyroid adenomas pose significant diagnostic and therapeutic challenges due to their atypical locations outside the usual anatomical boundaries of the parathyroid glands. These adenomas, which represent a small percentage of primary hyperparathyroidism cases, are often found in areas such as the mediastinum, thymus, or retroesophageal space. Their ectopic nature complicates diagnosis, as traditional neck imaging techniques may fail to localize these glands. We present the case of a 27-year-old female who initially presented with nausea, vomiting, severe hypercalcemia, and elevated parathyroid hormone (PTH) levels. Despite being advised to consult an endocrinologist, she experienced difficulty scheduling an appointment. Due to persistent symptoms and laboratory abnormalities, she was subsequently admitted to the hospital. Initial neck imaging failed to identify the parathyroid adenoma. However, subsequent imaging, including parathyroid scintigraphy, revealed an ectopic parathyroid adenoma located in the mediastinum. The patient underwent a successful robotically assisted thymectomy, guided by intraoperative PTH monitoring, which resulted in the resolution of hypercalcemia and normalization of PTH levels. This case underscores the importance of a comprehensive diagnostic approach when dealing with ectopic parathyroid adenomas. Parathyroid scintigraphy, in particular, proves to be a critical tool due to its high sensitivity in detecting ectopic glands. Moreover, our findings emphasize the need for a high index of suspicion for ectopic parathyroid adenomas, especially when conventional neck imaging is inconclusive in cases of hyperparathyroidism. Timely and accurate diagnosis is essential for facilitating precise surgical intervention, ultimately leading to improved patient outcomes.