International Journal For Multidisciplinary Research

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Recurrent Hyperparathyroidis Revealing Parathyromatosis : a Case Report

Author(s) Dr. Zineb Serhane, Dr. Widad Moussaoui, Prof. Dr. El Azime Zineb, Prof. Dr. Essafi Mohammed Amine, Prof. Dr. Aynaou Hayat, Prof. Dr. Salhi Houda
Country Morocco
Abstract Introduction:
Parathyromatosis is an extremely rare cause of recurrent or persistent primary hyperparathyroidism (PHPT), usually resulting from intraoperative seeding of parathyroid tissue following capsular rupture drecurruring surgery. Its diagnosis is difficult and may mimic parathyroid carcinoma.

Case Report:
We report the case of a 50-year-old woman with recurrent PHPT after three parathyroid surgeries. The first operation in 2012 for a right inferior parathyroid adenoma achieved temporary remission. Two further recurrences occurred in 2017 and 2022, each treated surgically, but postoperative hypercalcemia and elevated parathyroid hormone (PTH) persisted. Cervical ultrasound and 18F-fluorocholine PET/CT revealed multiple small hypermetabolic nodules scattered in the right neck region, consistent with secondary parathyromatosis. Given the patient’s refusal of further surgery, medical treatment with the calcimimetic cinacalcet was initiated, allowing long-term biochemical control at a dose of 120 mg/day.

Conclusion:
Parathyromatosis should be considered in any patient with multiple recurrences of PHPT after parathyroidectomy. High-performance imaging, especially 18F-fluorocholine PET/CT, is essential for localization. Careful handling of parathyroid glands during surgery is crucial to prevent this rare but challenging complication. While surgery remains the treatment of choice, cinacalcet can represent an effective alternative for non-surgical candidates.
Keywords Parathyromatosis, Recurrent hyperparathyroidism, Persistent hyperparathyroidism, 18F-fluorocholine PET/CT, Parathyroid carcinoma, Cinacalcet, Calcimimetic, Parathyroid surgery
Field Medical / Pharmacy
Published In Volume 7, Issue 6, November-December 2025
Published On 2025-12-13
DOI https://doi.org/10.36948/ijfmr.2025.v07i06.63276
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