Giant Parathyroid Adenoma with Delayed Hungry Bone Syndrome: A Case Report
https://doi.org/10.15605/jafes.041.S1
- Author:
Aina Mardiah Zulkifle
1
;
Nurain Mohd Noor
2
;
Zulaikha Che Che Embi
3
;
Noor Lita Mohd Adam
4
Author Information
1. Hospital Canselor Tuanku Muhriz UKM;Endocrine Unit, Internal Medicine Department, Hospital Putrajaya
2. Endocrine Unit, Internal Medicine Department, Hospital Putrajaya
3. Jabatan Patologi, Hospital Putrajaya
4. Endocrine Unit, Internal Medicine Department, Hospital Tuanku Ja’afar Seremban
- Publication Type:Journal Article
- MeSH:
Parathyroid Neoplasms
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):70-71
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Giant parathyroid adenomas (GPAs), defined as lesions
>3.5 g, are rare. Their size, biochemical severity, and
compressive features often mimic carcinoma, creating
diagnostic and surgical challenges.
Case:A 33-year-old female was incidentally found to have
hypercalcemia during evaluation after her newborn
developed severe hypocalcemic seizures requiring NICU
admission. Maternal calcium was 2.95 mmol/L with hypophosphatemia. Subsequent reviews showed persistent
hypercalcemia (3.15–3.3 mmol/L), hypophosphatemia (0.32–
0.51 mmol/L), and markedly elevated intact parathyroid
hormone (85–96 pmol/L). She had vitamin D deficiency,
very high alkaline phosphatase (1,329 U/L), and progressive bone pain with reduced mobility. Bone mineral density
revealed Z scores of −2.9 (hip) and −3.3 (lumbar spine).
Multiphase computed tomography demonstrated a multilobulated 6.9 cm mass extending from C5 to T2, compressing
the esophagus and raising suspicion for carcinoma.
Endoscopic evaluation excluded mucosal invasion. She
underwent en bloc left inferior parathyroidectomy with
hemithyroidectomy. Intraoperative parathyroid hormone
fell from 41.7 to 13.4 pmol/L, confirming complete excision.
The gland measured 65 × 20 × 15 mm and weighed 18.4 g.
Histopathology revealed a hypercellular parathyroid tumor
with endocrine atypia but no invasion, consistent with
a giant adenoma.
Postoperatively, calcium was initially stable (1.99 mmol/L
at discharge) but fell to 1.68–1.82 mmol/L at 2 weeks despite
high-dose supplementation. Hypocalcemia persisted for 6
weeks, consistent with delayed hungry bone syndrome,
likely precipitated by preoperative vitamin D deficiency,
markedly elevated alkaline phosphatase, and low bone
mineral density. With intensive supplementation, calcium
gradually stabilized, and symptoms improved.
Conclusion:GPAs can closely mimic carcinoma, with endocrine atypia
complicating histopathological interpretation. This case
illustrates both diagnostic overlap and the unusual, delayed
onset of hungry bone syndrome, emphasizing the need
for preoperative risk assessment, correction of metabolic
deficiencies, and extended postoperative monitoring. Rare
presentations such as delayed hungry bone syndrome
refine management strategies and improve outcomes in
primary hyperparathyroidism.
- Full text:202608031720504378EP_A093.pdf
