Virginia Via Research Day Book 2026

Medical Student Research Case Reports

46 PRIMARY HYPERPARATHYROIDISM WITH NORMAL PARATHYROID HISTOLOGY: A RARE CASE OF SURGICAL CURE

Narmeen Rasul, OMS-III; Mahya Abedi-Jafari, OMS-III; Aliza Ishrat, OMS-III; Daniel Tershak, MD Corresponding author: nrasul01@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

who presents with recent onset osteomyelitis, syncope, fatigue, multiple kidney stones, and nonspecific body pains. He was admitted for chest pain thirty three times within two years but a cardiovascular workup was largely unremarkable and the source of his pain was not identified. However, there was an incidental left 10 mm adrenal adenoma found on imaging. When following up with endocrinology for diabetes and the adrenal adenoma, the patient was found to have a calcium level of 10.7, ionized calcium of 1.38, parathyroid level of 57, and 24 hour urine calcium of 538, consistent with primary hyperparathyroidism. With regards to the adrenal adenoma, a dexamethasone suppression test was normal, indicating subclinical Cushing’s syndrome. Although a parathyroid ultrasound scan was normal, the patient desired surgical options given his extensive symptoms and elevated urine calcium with no other attributable cause. A laparoscopic left adrenalectomy with four parathyroid gland exploration was done without complications. All four parathyroid glands were histologically reviewed and found to have normal cellularity. After surgery, the patient was found to have resolution of nonspecific symptoms with calcium and ionized calcium returning to normal levels.

Background: Primary hyperparathyroidism (PHPT) is an endocrine disorder caused by autonomous overproduction of parathyroid hormone (PTH), often from a single parathyroid adenoma, that leads to hypercalcemia and its systemic consequences. It is more common in adults, particularly postmenopausal women, and prevalence rises with age. PHPT may present with a wide spectrum of findings such as nephrolithiasis, renal impairment, cortical bone loss and fragility fractures, gastrointestinal symptoms, or overt “stones, bones, groans, and psychiatric overtones.” The diagnosis is often made based on hypercalcemia with an inappropriately elevated PTH. Imaging, such as ultrasound, is used for localization prior to surgery but is not diagnostic. A definitive cure for most patients is achieved with parathyroidectomy, while medical management or observation are options for selected asymptomatic patients following guideline-based criteria from the American Association of Endocrine Surgeons. Case Presentation: This case follows a 52 year old male with a past medical history of type 2 diabetes, obesity, polycythemia vera, hypertension, COPD, chronic kidney disease, and hyperlipidemia

Conclusion: This case highlights a rare presentation of primary hyperparathyroidism in which biochemical evidence of disease and significant symptoms were present despite all four parathyroid glands appearing histologically normal. The patient’s prolonged, nonspecific complaints were initially attributed to multiple comorbidities, delaying recognition of a unifying endocrine cause. His clear symptomatic improvement after surgery demonstrates that functional hyperparathyroidism can occur even without identifiable structural pathology. Early consideration of this possibility is important, as timely intervention can reduce morbidity and improve outcomes in patients with otherwise unexplained hypercalcemia and recurrent related symptoms.

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84 Edward Via College of Osteopathic Medicine (VCOM)