Primary Hyperparathyroidism Caused by Parathyroid Adenoma Diagnosed by Fine-Needle Aspiration Washout and Successfully Treated with Ablation

Abstract

Primary hyperparathyroidism usually happens when a single parathyroid gland grows a non-cancerous tumour called an adenoma. The standard treatment has traditionally been surgery. But recently, for certain patients, less invasive heat-based techniques have started to show promise as an alternative.
Case presentation: Take the case of a 30-year-old woman who came in feeling more and more tired and had an odd, intermittent choking sensation in her neck. Blood tests showed her parathyroid hormone (PTH) was high, while her phosphorus was low and she was low in vitamin D. An ultrasound of her neck found a suspicious spot on the left side, about the size of 21 × 13.4 × 6.3 mm, looking very much like a parathyroid adenoma. To confirm it, doctors did a fine-needle biopsy. When they washed out the needle and tested the fluid, the PTH level was over 5000 pg/mL—clearly confirming the diagnosis. The patient then had an ultrasound-guided radiofrequency ablation done by an interventional radiologist. After the procedure, the adenoma shrank significantly—down to 10 × 6.5 × 6.2 mm. Her lab results improved a lot too: her PTH dropped to 22.6 pg/mL, and her calcium normalised to 9.6 mg/dL. This case shows that radiofrequency ablation could be a real option for certain people with parathyroid adenoma—offering good results with less invasiveness and faster biochemical recovery.