What should be considered to avoid delayed management of parathyroid adenoma: a case report
Abstract
Introduction and importance: Parathyroid adenoma often remains undiagnosed for a prolonged period, primarily due to its non-specific clinical presentation. Patients frequently seek treatment from non-endocrinological specialists for symptoms such as bone pain and musculoskeletal discomfort, which may delay appropriate diagnosis and management.
Case presentation: We report the case of a 46-year-old patient with a 2-year history of diffuse pain in both the upper and lower limbs. He had been managed by a rheumatologist with a diagnosis of polyarthralgia, with no clinical improvement despite treatment. The turning point in the diagnostic process occurred when the patient consulted a neurologist for persistent headaches. On physical examination, a palpable mass was noted in the lower anterior neck. Subsequent ultrasound imaging revealed a suspicious nodule, prompting referral to an endocrinologist. Comprehensive laboratory and imaging evaluations demonstrated markedly elevated parathyroid hormone (PTH) and serum calcium levels, bilateral nephrocalcinosis, significant osteoporosis, compression fractures of the lumbar vertebrae, and diffuse osteolytic bone lesions. Parathyroid scintigraphy confirmed the presence of a parathyroid adenoma. On physical examination, the patient exhibited a characteristic waddling gait, attributed to lumbar vertebral fractures and proximal muscle weakness secondary to primary hyperparathyroidism (PHPT). The patient underwent surgical excision of the…
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