{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:23:41Z","timestamp":1786685021613,"version":"build-2736575974"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hyperparathyroidism includes conditions marked by excessive secretion of parathyroid hormone (PTH), resulting in disruptions in calcium-phosphate metabolism. In individuals with chronic kidney disease (CKD), differentiating secondary hyperparathyroidism from tertiary hyperparathyroidism is frequently challenging due to the overlapping biochemical and clinical characteristics. Ectopic mediastinal parathyroid adenomas are uncommon and complicate localisation and therapy further.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We present a 66-year-old female with chronic kidney disease, hypertension, and ischaemic heart disease, who had increasing dyspnoea initially attributed to heart failure. Laboratory assessment indicated PTH 238.8 pmol\/L, corrected calcium 2.545 mmol\/L, phosphorus 1.389 mmol\/L, and vitamin D 39.8 nmol\/L, suggesting advanced hyperparathyroidism. The primary diagnostic issue was distinguishing tertiary hyperparathyroidism from secondary hyperparathyroidism in the context of chronic kidney disease (CKD). Localisation was accomplished with Tc-99m sestamibi SPECT\/CT, revealing a 3 \u00d7 2 cm anterior mediastinal lesion consistent with an ectopic parathyroid adenoma. Echocardiography demonstrated significant concentric left ventricular hypertrophy and a large pericardial effusion. Definitive surgical treatment consisting of bilateral neck exploration with thoracoscopic excision of the anterior mediastinal parathyroid gland was recommended following stabilization. However, after counseling, the patient declined surgical intervention and was managed conservatively with ongoing nephrology and endocrinology follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights the diagnostic complexity of tertiary hyperparathyroidism in CKD and the crucial role of multimodal imaging in localising ectopic adenomas. Integrating biochemical, radiological, and clinical findings is essential for accurate diagnosis and timely surgical planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights how modest biochemical irregularities and unusual cardiopulmonary symptoms can obscure ectopic parathyroid disease, emphasising the importance of maintaining a high index of suspicion to guide optimal clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12902-025-02160-3","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T05:33:28Z","timestamp":1767418408000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Tertiary hyperparathyroidism with ectopic mediastinal parathyroid adenoma in a patient with chronic kidney disease and cardiovascular complications: a case report"],"prefix":"10.1186","volume":"26","author":[{"given":"Mohammed M.","family":"Salahaldin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azzam","family":"Zrineh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah Abu","family":"Keshek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamza","family":"Karmi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montaser","family":"Badran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Bourini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"2160_CR1","unstructured":"Helbing A, Leslie SW, Levine SN, Primary Hyperparathyroidism. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Stephen Leslie declares no relevant financial relationships with ineligible companies. Disclosure: Steven Levine declares no relevant financial relationships with ineligible companies: StatPearls Publishing Copyright \u00a9 2025, StatPearls Publishing LLC; 2025."},{"key":"2160_CR2","unstructured":"Muppidi V, Meegada SR, Rehman A, Secondary Hyperparathyroidism. StatPearls. Treasure Island (FL) with ineligible companies. Disclosure: Sreenath Meegada declares no relevant financial relationships with ineligible companies. Disclosure: Anis Rehman declares no relevant financial relationships with ineligible companies: StatPearls Publishing Copyright \u00a9 2025, StatPearls Publishing LLC; 2025."},{"issue":"5","key":"2160_CR3","doi-asserted-by":"publisher","first-page":"100238","DOI":"10.1016\/j.clinme.2024.100238","volume":"24","author":"SH Tsai","year":"2024","unstructured":"Tsai SH, Kan WC, Jhen RN, Chang YM, Kao JL, Lai HY, et al. Secondary hyperparathyroidism in chronic kidney disease: A narrative review focus on therapeutic strategy. Clin Med. 2024;24(5):100238.","journal-title":"Clin Med"},{"key":"2160_CR4","doi-asserted-by":"crossref","unstructured":"Naveh-Many T, Volovelsky O. Parathyroid cell proliferation in secondary hyperparathyroidism of chronic kidney disease. 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J Laparoendoscopic Adv Surg Techniques Part A. 2024;34(8):677\u201381.","journal-title":"J Laparoendoscopic Adv Surg Techniques Part A"},{"issue":"12","key":"2160_CR17","first-page":"e75096","volume":"16","author":"S Khanom","year":"2024","unstructured":"Khanom S, Singh K, Blinkhorn LS, Ravendran K. Robotic resection of an ectopic parathyroid gland: A systematic review. Cureus. 2024;16(12):e75096.","journal-title":"Cureus"},{"issue":"1","key":"2160_CR18","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1177\/15569845231225668","volume":"19","author":"M Anemoulis","year":"2024","unstructured":"Anemoulis M, Kachtsidis V, Geropoulos G, Panagiotopoulos N. Robot-Assisted thoracoscopic resection of ectopic parathyroid tissue in mediastinum: A scoping review. Innovations (Philadelphia Pa). 2024;19(1):17\u201322.","journal-title":"Innovations (Philadelphia Pa)"}],"container-title":["BMC Endocrine Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12902-025-02160-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-025-02160-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12902-025-02160-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T13:37:28Z","timestamp":1770039448000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12902-025-02160-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,2]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["2160"],"URL":"https:\/\/doi.org\/10.1186\/s12902-025-02160-3","relation":{},"ISSN":["1472-6823"],"issn-type":[{"value":"1472-6823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,2]]},"assertion":[{"value":"16 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This case report was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was not required for this single-patient case description, according to the policies of Al-Quds University Institutional Review Board. Written informed consent for participation and publication of clinical details and images was obtained from the patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of clinical details and accompanying images was obtained from the patient. The patient was provided with a copy of the manuscript prior to submission to ensure full awareness of its content.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"30"}}