Atypically presented dysphagia in a patient with primary hyperparathyroidism that resolved after parathyroidectomy: A case report

ABSTRACT Introduction: Dysphagia is a rare initial manifestation of primary hyperparathyroidism, which typically presents with gastrointestinal symptoms like anorexia and constipation. This case presentation aims to describe swallowing difficulty as a potential primary symptom of parathyroid hormone (PTH)-mediated hypercalcemia. Presentation of case: An elderly Palestinian female presented with a two-year history of progressive dysphagia, along with mood disturbances and increased urination. Her medical history included osteoporosis and hyperparathyroidism. Laboratory tests showed elevated PTH and calcium levels. Imaging, including neck ultrasound (US) and Tc99m sestamibi scan, identified a parathyroid adenoma. Despite normal findings on esophagogastroduodenoscopy, a focused single parathyroidectomy was performed. Post-surgery, the patient's dysphagia resolved completely, and her calcium and PTH levels normalized. Discussion: This case highlights an atypical presentation of PTH-mediated hypercalcemia where dysphagia was the primary symptom. Literature review shows similar cases where parathyroid adenomas presented with unusual symptoms, emphasizing the need for thorough diagnostic evaluation. The resolution of dysphagia following surgery suggests a likely correlation between hypercalcemia and dysphagia, implying a possible causative association. Conclusion: This case demonstrates dysphagia as a rare but significant symptom of hypercalcemia in a patient with a small parathyroid adenoma. Considering its size, it was unlikely to cause dysphagia through mechanical obstruction. Thus, a functional cause linked to hypercalcemia was likely to be the cause of dysphagia. Surgical removal of the adenoma resulted in resolution of symptoms. A literature review was performed, which revealed similar cases of dysphagia related to hypercalcemia, supporting the fact that in this patient, dysphagia was related to the hypercalcemia. Highlights