Spontaneous haemorrhagic infarction of parathyroid adenoma

Parathyroid adenoma is a common cause of primary hyperparathyroidism. There are few case reports in the literature of spontaneous infarction of the adenoma leading to temporary or permanent resolution of hyperparathyroidism. We present the case of a 64-year-old white male with persistent hypercalcaemia of 11 - 13 mg/dl of total calcium, and serum albumin of 3.6 - 4 gm/dl for more than a year, low phosphate level of 3 - 3.5 mg/dl, ratio of chloride to phosphate more than 30, and elevated intact PTH level of 49 - 270 pg/ ml. He had history of diabetes mellitus, hypertension, dyslipidaemia, and chronic renal insufficiency. A renal biopsy showed focal segmental glomerulosclerosis. A Technetium Sestamibi scan showed residual uptake in the inferior aspect of right lobe of thyroid gland suggesting a parathyroid adenoma. On surgical exploration, two parathyroid glands on the left were normal grossly, and the right inferior gland biopsy was normal. The right superior gland was located posteriorly almost in the retro-oesophageal space. The pathology of this gland confirmed an extensive haemorrhagic infarction with surrounding fibroblastic proliferation. The patient has remained normocalcaemic since then for 18 months of follow-up. Several cases of spontaneous infarction of parathyroid adenoma have been reported previously. Eight of these cases had various symptoms like neck pain, dysphagia, neck mass, hoarseness, cough, tetany, and seizures. 7 out of these 12 cases had a palpable neck mass at infarction. Our patient remained asymptomatic. His corrected total serum calcium immediately after the surgery was 9.8 mg/dl and was 12.3 mg/dl 12 days before the surgery.