Metachronous parathyroid adenoma characterised by recurrent nephrolithiasis

Abstract

Hyperparathyroidism is often diagnosed after identifying hypercalcaemia through routine testing in asymptomatic patients; however, many patients experience severe and painful symptoms related to their diagnosis, including nephrolithiasis and bone pain with osteoporosis. Double adenomata are an uncommon cause of hyperparathyroidism, and they occasionally occur metachronously with recurrent symptoms years apart. This case report examines a woman in her 60s with a history of parathyroid adenoma 9 years earlier who presented with recurrent nephrolithiasis. She was found to have a recurrence of primary hyperparathyroidism after more than a year of recurrent urinary tract infections, nephrolithiasis and bacteraemia. A neck exploration revealed a metachronous parathyroid adenoma, which was removed with complete resolution of symptoms. Her case demonstrates the importance of evaluating patients with nephrolithiasis for hyperparathyroidism and communicating abnormal laboratory results with the patient in a hospital setting. It also provides the opportunity to examine the rare diagnosis of a metachronous parathyroid adenoma.