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Despite initial surgery for hypercellular tissue, calcium and PTH remained elevated until an ectopic paraesophageal parathyroid adenoma was discovered and resected, resolving PHPT.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/primary-hyperparathyroidism-from-concurrent-parathyroid-hyperplasia-and-ectopic-parathyroid-adenoma-a-case-report/444189/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/primary-hyperparathyroidism-from-concurrent-parathyroid-hyperplasia-and-ectopic-parathyroid-adenoma-a-case-report/444189.png","ImageObject",300,407,{"name":42,"@type":43},"Nguyễn 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Volume 2026, Article ID 2316653, 4 pages [https://doi.org/10.1155/crie/2316653](https://doi.org/10.1155/crie/2316653)  \nCase Report  \nPrimary Hyperparathyroidism From Concurrent Parathyroid Hyperplasia and Ectopic Parathyroid Adenoma: A Case Report  \nJune Yao , Clarice Szeto, Chantal Riba, and Chau Nguyen  \nDepartment of Surgery, Community Memorial Hospital, 147 N. Brent Street, Ventura 93003, California, USA  \nCorrespondence should be addressed to June Yao; [jyao1@cmhshealth.org](jyao1@cmhshealth.org)  \nReceived 19 June 2025; Revised 13 November 2025; Accepted 16 December 2025  \nAcademic Editor: Kalyani Sen  \nCopyright © 2026 June Yao et al. Case Reports in Endocrinology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nPrimary hyperparathyroidism (PHPT), whether caused by an adenoma or hyperplasia, can be curative with parathyroidectomy. However, persistently elevated parathyroid hormone (PTH) despite parathyroidectomy suggests multigland disease. We present a case of concurrent single-gland parathyroid hyperplasia and an ectopic parathyroid adenoma in a 72-year-old woman with longstanding PHPT. Despite persistently elevated calcium and PTH levels, all diagnostic imaging was negative for parathyroid hyperplasia and adenoma. PTH remained elevated despite initial parathyroidectomy for hypercellular tissue consistent with hyperplasia. An ectopic paraesophageal parathyroid adenoma was ultimately discovered and resected, resolving the PHPT. This case emphasizes that negative imaging does not exclude active parathyroid disease.  \nKeywords: case report; ectopic parathyroid adenoma; intraoperative PTH; parathyroid hyperplasia; parathyroidectomy  \n1. Introduction  \nPrimary hyperparathyroidism (PHPT) is characterized by excessive secretion of parathyroid hormone (PTH) and is the most common cause of hypercalcemia. Parathyroid adenoma accounts for 80%–85% of PHPT cases, while parathyroid hyperplasia represents approximately 15%–20%[1]. The average parathyroid gland is approximately 6mm by 4mm, weighing only 20–40mg [2]. Removal of the affected glands is usually curative. Persistent or recurrent PHPT can be attributed to inadequate resection secondary to an ectopic gland (estimated at up to 5%) or double adenoma, which may be found in 3%–12% of the time [3].  \nEctopic parathyroid glands result from abnormal migration of parathyroid cells during embryogenesis. Inferior parathyroids are most frequently associated with the thymus or the thyroid gland, while the most common positions for ectopic superior parathyroids are the tracheoesophageal groove and retroesophageal region [4]. Ultrasound and sestamibi scintigraphy remain the primary localization studies for enlarged parathyroid glands. When initial imaging is inconclusive,  \ncontrast-enhanced CT, MRI, or advanced studies such as 4DCT, PET radiotracers, or intraoperative gamma probes may be indicated [5, 6]. Upon literature review, only one similar case of coexisting parathyroid hyperplasia and ectopic parathyroid adenoma has been reported. In this case report, we present a rare case of PHPT due to single-gland parathyroid hyperplasia and an ectopic paraesophageal adenoma, managed successfully with bilateral neck exploration and intraoperative PTH monitoring. This case report has been reported in line with the CARE Criteria [7].  \n2. Case Presentation  \nA 72-year-old Caucasian female with a long-standing history of PHPT presented with recurrent hospital admissions for symptomatic hypercalcemia. She had an extensive medical history that included hypertension, hyperlipidemia, Type 2 diabetes, heart failure with preserved ejection fraction, bipolar disorder, uterine cancer with metastases to the lung treated with total abdominal hysterectomy, and left lower lobectomy","cbCaipnCH8E7ED8i","https://ap.wps.com/l/cbCaipnCH8E7ED8i","pdf",1360849,"English","# Introduction\n# Case Presentation\n# Diagnostic Assessment\n# Therapeutic Intervention","[{\"question\":\"Why can PHPT persist even after parathyroidectomy?\",\"answer\":\"Persistently elevated PTH after parathyroidectomy can suggest multigland disease, such as missed ectopic glands or additional abnormal parathyroid tissue.\"},{\"question\":\"What made localization challenging in this patient?\",\"answer\":\"Despite ongoing biochemical abnormalities, CT imaging, ultrasound, and sestamibi scans did not reveal parathyroid hyperplasia or an adenoma initially.\"},{\"question\":\"How was the final diagnosis and treatment achieved?\",\"answer\":\"Bilateral neck exploration ultimately identified an ectopic paraesophageal parathyroid adenoma, which was resected, leading to resolution of PHPT.\"}]","Primary Hyperparathyroidism From Concurrent Parathyroid Hyperplasia and Ectopic Parathyroid Adenoma - A Case Report | PDF",1790707153]