A Giant Parathyroid Adenoma in an Adolescent Male

A 16-year-old male patient arrived at the emergency department with a ten-day history of persistent nausea, vomiting, and headaches. His symptoms included constant nausea, worsened by eating and drinking, and frequent episodes of nonbloody and nonbilious vomiting. He described his headaches as tension-type, located in both temporal areas and unaffected by changes in position or pain relievers. Additionally, he reported excessive thirst without increased urination, constipation, and several months of leg pain, which was initially attributed to growing pains. The patient had previously sought medical care for viral gastritis but had not found relief, prompting his visit to the emergency department.

Upon examination, he was afebrile, with a normal heart rate and respiratory rate. However, his blood pressure was elevated. A firm mass was detected over the left thyroid lobe. Other physical examinations were normal. Laboratory results revealed significantly elevated serum calcium levels, a highly elevated intact parathyroid hormone (PTH) level, and low vitamin D levels. Imaging showed a parathyroid mass, and a diagnosis of primary hyperparathyroidism (PHPT) due to a parathyroid adenoma was considered. The mass was surgically removed, and the patient experienced postoperative complications related to electrolyte imbalances.

This case is noteworthy because of the palpable parathyroid mass and its size, raising concerns about parathyroid carcinoma. However, the pathology was negative for malignancy. The patient underwent surgery to remove the parathyroid mass and part of the thyroid, with positive outcomes.

The patient was started on medications to manage calcium levels and discharged with ongoing care. Genetic testing for related conditions was negative. This case emphasizes the importance of considering rare conditions like PHPT in adolescent patients presenting with unusual symptoms, as early diagnosis and intervention are critical for their well-being.

Muse J, Palmer R, Auriemma J. A Giant Parathyroid Adenoma Presenting as Nausea, Vomiting, and Headaches in an Adolescent Male. Case Reports in Pediatrics. 2023; 2023. https://doi.org/10.1155/2023/5530269