Copyright (c) 2026 Moisés Del Valle, María De La Cruz Castillo, Milagro De La Cruz, Jose Delgado, Raúl Díaz
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Primary hyperparathyroidism is one of the most common causes of hypercalcemia in adults and is usually related to parathyroid adenomas. When the glands are located in ectopic sites, especially in retrotracheal positions, the diagnostic process becomes considerably more challenging. We report the case of a 53-year-old woman who presented with right flank colicky pain, nausea, vomiting, chronic kidney disease, and long-standing nephrolithiasis. Initial studies showed bilateral nephrolithiasis, grade IV hydronephrosis, calcified JJ stents, hypercalcemia (12.19 mg/dL), and a markedly elevated PTH level (473.20 pg/mL). A 99mTc-MIBI SPECT/CT scan localized a right retrotracheal ectopic parathyroid adenoma. After renal stabilization and urologic management, a parathyroidectomy was performed, confirming an adenoma of approximately 3 cm. Postoperatively, PTH decreased to 22.6 pg/mL, serum calcium normalized, and the patient’s clinical course improved significantly. This case underscores the value of hybrid imaging and the need to consider atypical gland locations in patients with recurrent nephrolithiasis and persistent hypercalcemia.
