Primary hyperparathyroidism resolution via auto-infarction discovered intraoperatively

Authors

  • Trisha Clark Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
  • Natalia Barragan Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
  • Samah Ali, MD Department of Pathology, University of Toledo College of Medicine and Life Sciences, Toledo, OH
  • Joseph Sferra, MD Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, USA. https://orcid.org/0000-0002-2731-2843

DOI:

https://doi.org/10.46570/utjms-2024-1154

Keywords:

parathyroid, hyperparathyroidism, auto-infarction, adenoma, hypercalcemia

Abstract

Primary hyperparathyroidism is a condition frequently attributed to the excessive secretion of parathyroid hormone (PTH), often stemming from adenoma, hyperplasia, or carcinoma. While the conventional approach to addressing this condition involves surgical intervention, there exist rare instances where spontaneous resolution occurs, typically because of auto-infarction or necrosis of the parathyroid adenoma. In this report, we present the case of a 64-year-old male with hypercalcemia, referred for surgical intervention. Preoperative imaging unveiled a nodular lesion, and intraoperatively, an acutely infarcted adenoma was discovered. Microscopic examination confirmed parathyroid necrosis. Similar cases documented in the medical literature shed light on the potential for non-surgical management options. Factors such as cinacalcet treatment and hypocalcemia-inducing medications have been explored, suggesting alternative approaches to address this condition. Furthermore, cases of spontaneous remission highlight the paramount importance of long-term follow-up in managing primary hyperparathyroidism, ensuring comprehensive and individualized patient care. The awareness of these infrequent occurrences significantly contributes to well-informed decision-making within the medical community.

Author Biographies

Natalia Barragan, Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH

surgery resident

Nickname: Nat
Hometown: Chowchilla, CA

Medical School: The University of Toledo College of Medicine & Life Sciences

Clinical Interests: Trauma, Critical Care, Acute Care Surgery, Minimally invasive surgery
Personal Interests: Reading, Triathlons, Cooking (mostly eating), Plants and Conservation.

Samah Ali, MD, Department of Pathology, University of Toledo College of Medicine and Life Sciences, Toledo, OH

board certified pathologist

Anatomic & Clinical Pathology, Hematopathology

Active in North Carolina, previously practiced in Toledo, Ohio

Education: University of Toledo College of Medicine and Life Sciences (Department of Pathology)

Joseph Sferra, MD, Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH, 43614, USA.

Academic & Administrative Leadership
  • Department Chair: Chair of the Department of Surgery at the University of Toledo College of Medicine and Life Sciences.
  • Academic Rank: Professor of Surgery.
  • Executive Role: Academic Chief of Surgery for ProMedica.
  • Clinical Leadership: Surgery Service Chief for ProMedica Physicians.
Professional Credentials
  • Board Certification: Certified by the American Board of Surgery.
  • Professional Fellowship: Fellow of the American College of Surgeons (FACS).
  • Clinical Focus: Specializes in endocrine, hernia, breast, colorectal, and advanced laparoscopic surgery.
Educational Background
  • Doctor of Medicine (MD): The Ohio State University College of Medicine (1986).
  • Surgical Residency: Wayne State University Integrated General Surgery Program.
  • Executive MBA: University of Michigan Ross School of Business (2016).
 

References

Pokhrel B, Leslie S, Levine S. Primary hyperparathyroidism. StatPearls, 2023. https://www.ncbi.nlm.nih.gov/books/NBK441895/

Kara E, Della Valle E, De Vincentis S, Rochira V, Madeo B. Cured primary hyperparathyroidism after fine-needle aspiration biopsy-induced parathyroid disappearance. Endocrinol Diabetes Metab Case Rep, 2017. pp17-0125. https://pubmed.ncbi.nlm.nih.gov/29204278/

Kovacs K.A, Gay J.D. Remission of primary hyperparathyroidism due to spontaneous infarction of a parathyroid adenoma: Case report and review of the literature. Medicine (Baltimore), 1998. 77(6):398-402.

Liu Y., Li J., Liu H., Yang H., Qiao J., Wei T., Wang T., Yu Y. Spontaneous Remission After a Hypercalcemic Crisis Caused by an Intracystic Hemorrhage of Bilateral Parathyroid Adenomas: A Case Report and Literature Review. Front Endocrinol, 2021. https://pubmed.ncbi.nlm.nih.gov/34759892/

Minezaki M., Takashi Y., Ochi K., Mitsuoka R., Yamao Y., Kudo T., Kawanami D., Kobayashi K., Abe I. Reduction in parathyroid adenomas by cinacalcet therapy in patients with primary hyperparathyroidism. J Bone Miner Metab, 2021. 39(4): pp.583-588. https://pubmed.ncbi.nlm.nih.gov/33409573/

Novodvorsky P., Hussein Z., Arshad M.F., Iqbal A., Fernando M., Munir A., Balasubramanian S.P. Two cases of spontaneous remission of primary hyperparathyroidism due to auto-infarction: different management and their outcomes. Endocrinol Diabetes Metab Case Rep, 2019. pp18-0136. https://edm.bioscientifica.com/view/journals/edm/2019/1/EDM18-0136.xml

Cover of Translation: The University of Toledo Journal of Medical Sciences, Volume 16, Issue 2 (2026). The cover features a layered green collage design with the journal title "Translation" in large tan lettering across the top and the full journal name set within a darker green panel. The central artwork shows three overlapping human silhouettes in cream, tan, and brown tones layered with circular medical imaging insets - an ultrasound image and a chest radiograph. A gold DNA double helix runs vertically along the right edge, and a honeycomb hexagonal pattern textures the background, with the volume and issue designation ("Vol. 16, No. 2 (2026)") displayed in a rounded tan banner in the lower right corner.

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Published

2026-10-28

How to Cite

1.
Clark T, Barragan N, Ali, MD S, Sferra, MD J. Primary hyperparathyroidism resolution via auto-infarction discovered intraoperatively. Translation [Internet]. 2026 Oct. 28 [cited 2026 Oct. 30];16(2). Available from: https://openjournals.utoledo.edu/index.php/translation/article/view/1154

Issue

Vol. 16 No. 2 (2026): Volume 16, (2026)

Section

Case Reports

License

Copyright (c) 2026 Trisha Clark, Natalia Barragan, Samah Ali, MD, Joseph Sferra, MD (Author)

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