Doctors discovered an unusual case of a 66-year-old woman with kidney disease who developed a rare tumor in her parathyroid gland—a small gland that controls calcium levels in the body. What made this case tricky was that the tumor was hiding in her chest instead of her neck where these glands normally sit. The woman had symptoms like shortness of breath that doctors initially thought were from heart problems. Using special imaging scans, doctors found the hidden tumor and learned it was causing her body to produce too much parathyroid hormone, which was affecting her heart and kidneys. While surgery was recommended, the patient chose not to have the operation and instead received ongoing monitoring from her doctors.

The Quick Take

  • What they studied: A single patient with kidney disease who had an unusual parathyroid tumor located in her chest instead of her neck, causing her body to produce too much parathyroid hormone
  • Who participated: One 66-year-old woman with chronic kidney disease, high blood pressure, and heart disease who came to the hospital with increasing shortness of breath
  • Key finding: Doctors used special imaging scans to find a 3 × 2 centimeter parathyroid tumor hidden in the front of the patient’s chest, which was causing her body to produce excessive amounts of parathyroid hormone—about 6 times the normal level
  • What it means for you: This case reminds doctors to think about rare possibilities when patients with kidney disease have unusual symptoms. If you have kidney disease and experience unexplained shortness of breath or other new symptoms, mention all your symptoms to your doctor so they can investigate thoroughly

The Research Details

This is a case report, which means doctors documented the medical story of one specific patient to teach other doctors about an unusual situation. The patient was a 66-year-old woman with chronic kidney disease (a condition where the kidneys don’t work well) who came to the hospital complaining of increasing shortness of breath. Doctors ran blood tests and special imaging scans to figure out what was wrong.

The doctors used several types of tests to solve this medical puzzle. They measured hormone levels in the blood, took X-rays and CT scans of the chest, and used a special nuclear medicine scan called Tc-99m sestamibi SPECT/CT. This special scan helps doctors find parathyroid tumors because the tumor cells absorb a radioactive dye that shows up on the scan. They also did an echocardiogram (an ultrasound of the heart) to see how the heart was functioning.

Case reports are valuable because they describe rare or unusual medical situations that doctors might not see often. By publishing this case, the doctors help other physicians recognize similar situations in their own patients and know what tests to order.

This research approach is important because it highlights how tricky it can be to diagnose parathyroid problems in patients with kidney disease. When kidneys don’t work properly, they can trigger the parathyroid glands to produce too much hormone, which looks similar to when a tumor is causing the problem. The case also shows why doctors need to think creatively and use multiple types of imaging when patients have unusual symptoms that don’t fit the typical pattern.

This is a single case report, which means it describes just one patient’s experience. While case reports are useful for teaching doctors about rare situations, they cannot prove that something will happen to many people. The strength of this case is that the doctors used multiple types of tests and imaging to confirm their diagnosis. The weakness is that we cannot generalize from one patient to make broad recommendations for how to treat all similar patients. This case is most valuable as a learning tool for other doctors rather than as proof of a new treatment.

What the Results Show

The main discovery was that the patient had a parathyroid tumor (called an adenoma) located in the front of her chest, which is an unusual location since these glands normally sit in the neck. Blood tests showed the patient’s parathyroid hormone level was 238.8 pmol/L, which is about 6 times higher than normal. Her calcium level was also elevated at 2.545 mmol/L, and her phosphorus was low at 1.389 mmol/L. These blood test results suggested advanced hyperparathyroidism—a condition where the parathyroid glands produce too much hormone.

The special imaging scan (Tc-99m sestamibi SPECT/CT) clearly showed a 3 × 2 centimeter tumor in the front of the chest. This was the key finding that helped doctors understand why the patient’s parathyroid hormone was so high. The tumor was in an ectopic location, meaning it was in an unusual place rather than where these glands normally grow.

Heart imaging showed that the patient’s heart had developed thick walls (called left ventricular hypertrophy) from working too hard, likely due to the high calcium levels in her blood. She also had a large collection of fluid around her heart (pericardial effusion), which was probably contributing to her shortness of breath. These heart problems were serious complications from the parathyroid tumor.

The case revealed an important diagnostic challenge: distinguishing between secondary hyperparathyroidism (when kidney disease causes the parathyroid glands to overproduce hormone) and tertiary hyperparathyroidism (when the parathyroid glands become overactive and stop responding to normal feedback signals). In this patient, the presence of the tumor made it tertiary hyperparathyroidism. The patient’s vitamin D level was low at 39.8 nmol/L, which is common in kidney disease patients and can worsen parathyroid problems. The combination of the tumor, high hormone levels, and heart complications showed how interconnected these systems are—a problem in the parathyroid gland can directly damage the heart.

Ectopic parathyroid tumors (tumors in unusual locations) are rare, occurring in only about 16-20% of parathyroid cases. Most parathyroid tumors are found in the neck where these glands normally sit. This case is notable because it shows how an ectopic tumor can be hidden and cause serious complications before being discovered. The case also illustrates the challenge doctors face when treating patients with both kidney disease and parathyroid problems—the two conditions can mask each other and make diagnosis difficult. Previous research has shown that special imaging scans like the one used here are very helpful for finding ectopic parathyroid tumors.

This is a report of just one patient, so we cannot know if the findings apply to other people with similar conditions. The patient declined surgery, so we don’t know what the outcome would have been if she had chosen the surgical treatment that doctors recommended. The case report doesn’t include long-term follow-up information about what happened to the patient after she chose conservative management. Additionally, because this is a single case, we cannot compare different treatment approaches or determine which approach works best. Case reports are most useful for raising awareness about rare conditions rather than proving which treatments are most effective.

The Bottom Line

Based on this single case, there are no specific treatment recommendations that apply to everyone. However, the case suggests that patients with kidney disease who develop unusual symptoms—especially shortness of breath or signs of heart problems—should have thorough testing to check their parathyroid hormone levels. If a parathyroid tumor is found, especially in an unusual location, doctors should use multiple imaging methods to locate it precisely before planning treatment. Patients should discuss both surgical and non-surgical options with their doctors and make informed decisions based on their individual situation and preferences.

This case is most relevant to people with chronic kidney disease, especially those who develop new symptoms like shortness of breath or heart problems. Doctors who treat kidney disease patients should be aware that parathyroid problems can develop and cause serious complications. People with a family history of parathyroid disease or those who have had parathyroid problems in the past should discuss screening with their doctors. This case is less directly relevant to people without kidney disease, though it serves as a reminder that parathyroid tumors can occur in unusual locations.

In this patient’s case, the parathyroid tumor developed over time as her kidney disease progressed. The symptoms (shortness of breath) appeared gradually and were initially mistaken for heart failure. If a parathyroid tumor is discovered, the timeline for treatment depends on how severe the symptoms are and whether the patient chooses surgery or conservative management. Benefits from treatment may take weeks to months to become apparent as hormone levels normalize and the heart recovers from the stress of high calcium levels.

Want to Apply This Research?

  • If you have chronic kidney disease, track your symptoms weekly in an app, specifically noting: shortness of breath (rate 1-10), fatigue level, any heart palpitations, and any bone or muscle pain. Also log your doctor visits and any blood test results related to calcium, phosphorus, and parathyroid hormone levels.
  • Set monthly reminders to review your symptom log with your doctor. If you notice new or worsening symptoms—especially shortness of breath or chest discomfort—use the app to document them immediately and schedule a doctor’s appointment. Keep a record of all imaging tests and blood work results in the app so you and your doctor can track changes over time.
  • Create a long-term tracking system in the app that monitors parathyroid-related symptoms and test results. Set quarterly reminders to check in with your nephrology (kidney) and endocrinology (hormone) doctors. Use the app to track medication adherence and any dietary changes recommended by your doctors. Flag any new symptoms for immediate medical attention, and maintain a timeline of all test results to help doctors spot trends.

This case report describes one patient’s unique medical situation and should not be used to diagnose or treat yourself or others. If you have chronic kidney disease or symptoms like unexplained shortness of breath, chest pain, or heart palpitations, consult with your doctor immediately. Parathyroid conditions require professional medical evaluation and monitoring. The information in this article is educational and does not replace personalized medical advice from your healthcare provider. Always discuss any new symptoms or concerns with your doctor before making any changes to your treatment plan.