title: Surgical management of a giant parathyroid adenoma through minimal invasive parathyroidectomy. A case report.
abstract: BACKGROUND
  Primary hyperparathyroidism is a common endocrine disorder mostly associated to parathyroid adenomas. Although those tend to be small in size, rare cases of giant parathyroid adenomas may be present.
  
  
  METHODS
  A 42year old female was admitted in our department due to weakness and vague abdominal pain for the past 8 months. Preoperative laboratory exams indicated primary hyperparathyroidism as a cause to her symptomatology, with elevated values of parathormone and normal values of serum calcium. Ultrasound scan and 99m Tc-MIBI of her cervical region uncovered a giant 3×2cm parathyroid adenoma, located in the lower left thyroid lobe. Despite its size, the gland was successfully removed through implementation of minimal invasive parathyroidectomy. She was uneventfully discharged on the 1st postoperative day.
  
  
  CONCLUSIONS
  Although a common reason for developing hyperparathyroidism, parathyroid adenomas may rarely present with exaggerated dimensions and weight. Physical examination is usually unremarkable, while patients may present with symptomatology associated with elevated calcium levels. Treatment of this medical condition consists of surgical removal of the pathologic parathyroid gland either by bilateral neck exploration or through minimal invasive parathyroidectomy. Preoperative localization plays an important role in the second case, since the method focuses on resection of a pre-op marked hyperactive parathyroid gland, through a small incision.
  
  
  CONCLUSIONS
  Clinicians must be alerted of hyperparathyroidism in patients presenting with calcium associated symptomatology. Diagnosis is straightforward through laboratory exams, while surgery offers the only permanent treatment option.
authors.affiliation: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece. Electronic address: sachsamanis@hotmail.com.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sahsamanis
authors.affiliation: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Gkouzis
authors.affiliation: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Samaras
authors.affiliation: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
authors.forename: Dionysios
authors.initials: D
authors.lastname: Pinialidis
authors.affiliation: 1st Department of Surgery, 401 Army General Hospital of Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Dimitrakopoulos
keywords: Case report; Giant parathyroid adenoma; Minimal invasive parathyroidectomy; Primary hyperparathyroidism