Bone hunger and broken bones: managing a mediastinal parathyroid adenoma with pathological fracture of a femur in a young female.

Abstract

Primary hyperparathyroidism (PHPT) can have disparate systemic manifestations, one being metabolic bone disease leading to pathological fractures. Ectopic mediastinal parathyroid adenomas present with special diagnostic and surgical challenges. We present the case of a 23-year-old female patient who developed a pathological fracture of the right femur secondary to hyperparathyroidism. Initial hypocalcemia was treated with intravenous calcium gluconate before definitive treatment. Ultrasonography showed the presence of an ectopic parathyroid adenoma in the mediastinum that was safely excised by video-assisted thoracoscopic surgery (VATS). Anesthetic care involved combined general anesthesia (GA) and thoracic epidural anesthesia, one-lung ventilation (OLV), and vigorous intraoperative monitoring. The postoperative course was uncomplicated with good pain management and restoration of metabolism. Definitive orthopedic stabilization was to be done after endocrine optimization. This case implies the requirement of early diagnosis, multidisciplinary treatment, and staged operation in PHPT patients with complex skeletal presentation.

Keywords: Ectopic parathyroid adenoma; general anesthesia; hypocalcemia; one-lung ventilation; pathological
fracture

Citation: Shah B, Srinivasan NK, Mainaparambil IS. Bone hunger and broken bones: managing a mediastinal
parathyroid adenoma with pathological fracture of a femur in a young female. Anaesth. pain intensive care
2025;29(9):1339-42. DOI: 10.35975/apic.v29i9.3077

Received: September 15, 2025; Revised: October 26, 2025; Accepted: November 06, 2025