Parathyroid hyperplasia

Parathyroid hyperplasia is the diffuse enlargement of the parathyroid glands and is a less common cause of primary hyperparathyroidism.

Epidemiology

There is a female predilection (M:F = 1:3).

Clinical presentation

Most commonly an incidental finding of hypercalcemia in asymptomatic patients.

Pathology

In ~50% of cases, there is asymmetric enlargement of the parathyroid glands.

Etiology

• primary parathyroid hyperplasia
  • sporadic (80%): associated with exposure to radiation and lithium
  • familial (20%): associated with MEN 1 and MEN 2a
• secondary parathyroid hyperplasia
  • renal failure

Radiographic features

Nuclear medicine (Tc-99m MIBI) is the current modality of choice. 4DCT has been shown to be specific but not sensitive.

Differential diagnosis

• double parathyroid adenoma