Persistent hypocalcemia with elevated parathyroid hormone levels after long-term primary hyperparathyroidism: Report of a case

We report herein the case of a 48-year-old man with long-term persistent pr imary hyperparathyroidism (pHPT) despite undergoing a parathyroidectomy in 1976, followed by a reoperation in 1978, for whom resection of a parathyroi d adenoma in the upper mediastinum was eventually performed. His postoperat ive course was complicated by recurrent hypocalcemia refractory to oral cal cium substitution and significantly elevated levels of parathyroid hormone (PTH). The radiological findings are presented, and we discuss the possible reasons for the coincidence of severe hypocalcemia with increased PTH leve ls in association with pHPT.