A Rare Presentation of Giant Parathyroid Adenoma in the Context of Chronic Kidney Disease: A Case Report

Primary hyperparathyroidism (PHPT), a common endocrine disorder, disrupts calcium homeostasis and frequently arises from a parathyroid adenoma. In rare instances, giant parathyroid adenomas (GPAs), defined as those weighing more than 3.5 grams, may develop, posing diagnostic challenges, particularly in distinguishing them from parathyroid carcinoma (PC). A 74-year-old female patient with chronic kidney disease (CKD) of undetermined origin was referred for evaluation of suspected PHPT. Laboratory investigations revealed elevated serum calcium and parathyroid hormone (PTH) levels. Scintigraphy and ultrasonography suggested the presence of a GPA, leading to parathyroidectomy. Histopathological analysis of the resected adenoma confirmed a weight of 12 grams. While PHPT is often associated with smaller adenomas and may be asymptomatic, GPAs typically manifest with clinical symptoms. Imaging modalities, such as ultrasound and scintigraphy, are crucial in differentiating GPAs from PCs. These cases are uncommon and necessitate specialized management strategies. A comprehensive preoperative assessment, including appropriate imaging, is vital; fine-needle aspiration biopsy has low sensitivity. In cases of GPA, the surgical team must be prepared for potential conversion to radical oncological surgery to ensure complete resection.