Forearm Auto-Transplantation of Adenomatous Parathyroid Tissue to Prevent Post-Surgical Hypoparathyroidism: A Case Report.

BACKGROUND

Primary hyperparathyroidism (PHPT) is commonly treated surgically, though post-surgical hypoparathyroidism (PoSH) is a significant concern. Most studies focus on the auto-transplantation of healthy parathyroid glands, especially in multi-gland disease cases such as multiple endocrine neoplasia type 1 (MEN1) syndrome. However, limited data exist on auto-transplantation of pathological glands in single-gland disease due to concerns over recurrence.

OBJECTIVES

This case report describes the successful management of persistent PHPT using the auto-transplantation of adenomatous parathyroid tissue, preventing long-term hypoparathyroidism.

METHODS

A male patient in his 40s presented with persistent PHPT after previous surgery and inadvertent excision of three normal parathyroid glands. Re-operative exploration with excision of the last remaining parathyroid gland was performed, and the excised tissue was transplanted into the forearm.

RESULTS

Six months post-surgery, the patient was weaned off active vitamin treatments as hypoparathyroidism resolved. Five years after surgery, calcium and parathyroid hormone (PTH) levels remained normal, with no recurrence of hypercalcaemia.

CONCLUSIONS

This case illustrates that forearm auto-transplantation of pathological parathyroid tissue can restore parathyroid function, prevent long-term hypoparathyroidism and avoid recurrence over a five year period.