Giant parathyroid adenoma associated with brown sphenoidal tumor: case report

Abstract

Introduction: The main etiology of Primary hyperparathyroidism (PHTP) is a single parathyroid adenoma. Giant parathyroid adenomas, classified as such when they weigh > 3.5 g and are > 2 cm in diameter, are rarely described. The aim of this article is to report an PHTP case caused by giant parathyroid adenoma associated with severe osteitis fibrosa cystica lesions of atypical location. Case Report: Female, 40 years old, history of recurrent nephrolithiasis since the age of 20. The patient also reported intense headache. Imaging examination of the skull revealed an expansive lesion centered on the right sphenoid sinus, extending across part of the greater wing of the right sphenoid bone and affecting the clivus, characterized as a bone lesion suggestive of osteitis fibrosa cystica. Diagnostic investigation showed hypercalcemia (corrected total calcium 13.8 mg/dL; NR: 8.4-10.2 mg/dL) and hyperparathyroidism (PTH 1883 pg/mL; NR: 15-68.3 pg/mL). The surgical approach showed a parathyroid tumor measuring 4.8 x 2.7 x 1.8 cm. The patient also had bilateral renal lithiasis, an atrophic right kidney with staghorn calculi; in addition to multiple lytic lesions and some with insufflated appearance with cortical rupture in the vertebrae, ribs, hips, skull and mandible. Final Considerations: Giant parathyroid adenoma is a rare cause of PHPT and may present with severe fibrous osteitis and lithiasis, mimicking parathyroid carcinoma