title: Hyperparathyroid crisis due to asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland.
abstract: OBJECTIVE
  To report a rare case of primary hyperparathyroidism presenting with hyperparathyroid crisis due to parathyroid hyperplasia with ectopic glands.
  
  
  METHODS
  We present the initial clinical manifestations, laboratory results, radiologic and surgical findings, and management in a patient who had hyperparathyroid crisis. The pertinent literature and management options are also reviewed.
  
  
  RESULTS
  A 60-year-old female presented with hyperparathyroid crisis requiring preoperative stabilization with rehydration, diuresis, bisphosphonate therapy, and ultimately hemodialysis. Parathyroidectomy revealed asymmetric 4-gland hyperplasia, with a massive ectopic parathyroid gland in the tracheoesophageal groove extending into the mediastinum. Her postoperative course was complicated by hungry bone syndrome and hypocalcemia.
  
  
  CONCLUSIONS
  This case illustrates the rare occurrence of hyperparathyroid crises due to asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland.
authors.affiliation: Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, North Carolina.
authors.forename: Lauren F
authors.initials: LF
authors.lastname: Gratian
authors.affiliation: Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, North Carolina.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Hyland
authors.affiliation: Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina.
authors.forename: Randall P
authors.initials: RP
authors.lastname: Scheri