Jemds.com Case Report J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 10 / Issue 23 / June 07, 2021 Page 1809 Parathyroid Adenoma - From Surgical to Biochemical Cure Rupa Mehta 1 , Nitin M. Nagarkar 2 , Satish S.S. 3 , Ripu Daman Arora 4 , Jyoti Ranjan Das 5 1, 2, 3, 4, 5 Department of ENT & Head Neck Surgery, All India Institute of Medical Sciences, Raipur (AIIMS), Chhattisgarh, India. INTRODUCTION Parathyroid glands, minute endocrine glands, located in posterior aspect of thyroid glands secrete parathormone which plays an important role in maintaining calcium homeostasis in the body. The superior and inferior parathyroid glands originate from the 4 th and 3 rd branchial pouches respectively and migrate to occupy their normal positions in relation to the thyroid gland. 1 Hyperparathyroidism is defined as hyper functioning of parathyroid gland and can be primary, secondary or tertiary. Primary hyperparathyroidism is due to parathyroid gland proliferative disorders which include parathyroid adenoma, parathyroid hyperplasia, parathyroid carcinoma or in association with other conditions in MEN syndrome. In more than 90 % patients, primary hyperparathyroidism is caused by a single parathyroid adenoma. Very rarely double parathyroid adenomas are seen. Secondary Hyperparathyroidism is caused in response to any chronic hypocalcaemic conditions like renal failure, gastrointestinal malabsorption, dietary rickets & drugs, like phenytoin, phenobarbital & laxative. Prolonged secondary hyperparathyroidism leads to tertiary hyperparathyroidism due to autonomous secretion. The clinical presentation of hyperparathyroidism is classically described as kidney stones, abdominal groans, painful bones, psychic moans, and fatigue overtones. In the initial course of the disease, the patients present with vague symptoms of fatigue, muscle and joint pain, frequent urination, nausea, constipation, and decreased appetite. If high index of suspicion is maintained, they can be conveniently diagnosed by routine blood tests which show increased calcium levels. However, in India still majority of people are diagnosed when they present with palpable neck mass, skeletal manifestations or deranged renal function. We hereby present 5 cases of parathyroid adenoma managed at our centre over a period of 2 years. PRESENTATION OF CASE Case 1 A 48-year-old female presented with accidental fracture of left humerus after trivial injury. She presented to Orthopaedics outpatient department where she underwent closed reduction of fracture and cast was applied. X-Ray humerus (Figure 1) was suggestive of diffuse osteopenia with multiple well defined lytic lesions seen in left humerus at upper and mid shaft with pencil thin cortex. She gave a history of joint pain and muscle weakness. She didn’t have any history of body weight loss or loss of appetite. She denied having any neck swelling or dysphagia or change of voice. There was no past history suggestive of any chronic disease. During workup she was found to be hypercalcaemic. Serum calcium level was 14.9 mg / dl (normal 9 to 11 mg / dl), serum phosphorus level was 2.4 mg / dl (normal 2 to 4.5 mg / dl. Subsequently parathyroid hormone level was tested which was raised - 1900 pg / ml (normal 14 to 71 pg / ml), Alkaline Phosphatase level - 897 IU (normal 33 to 105 IU) serum magnesium 1.5 mg / dl (normal 1.7 to 2.4 mg / dl), 25 - OH vit D was 12.08 ng / dl (normal 20 to 50 ng / dl). Thyroid profile was normal. Other investigations revealed normal complete blood count and renal parameters. Corresponding Author: Dr. Jyoti Ranjan Das, Department of ENT & Head Neck Surgery, All India Institute of Medical Sciences, Raipur (AIIMS), Chhattisgarh, India. E-mail: jdbegins007@gmail.com DOI: 10.14260/jemds/2021/374 How to Cite This Article: Mehta R, Nagarkar NM, Satish SS, et al. Parathyroid adenoma - from surgical to biochemical cure. J Evolution Med Dent Sci 2021;10(23):1809-1814, DOI: 10.14260/jemds/2021/374 Submission 23-02-2021, Peer Review 14-04-2021, Acceptance 20-04-2021, Published 07-06-2021. Copyright © 2021 Rupa Mehta et al. This is an open access article distributed under Creative Commons Attribution License [Attribution 4.0 International (CC BY 4.0)]