A Rare Cause of Airway Collapse: Spontaneous Hemorrhage and Rupture of a Parathyroid Adenoma

Parathyroid adenomas are the most common cause of hyperparathyroidism, with a prevalence of 0.2-0.5% [1]. Patients classically present with signs and symptoms pertaining to and/or complications arising from hypercalcemia including osteoporosis and renal calculi. This case-based review will focus on atypical presentations of a parathyroid adenoma. The first documented report illustrating a parathyroid adenoma with extracapsular hemorrhage was in 1934 [2]. From the limited number of case reports published to date, presentation is classically with signs of extensive cervical ecchymosis in the region, as well as signs and symptoms secondary to compression of adjacent structures within the neck [3,4]. These cases are challenging to diagnosis pre-operatively as they occur abruptly, without a known precipitant and are infrequent. A further anomaly of this case relates to the biochemical markers being within the normal range; the mechanism by which this can occur will be explained. This is the first published case report of a patient presenting with stridor from an acute, near complete, airway obstruction with normal biochemical markers, as the initial presentation of a parathyroid adenoma, which required immediate surgical intervention.