Multimodal Imaging and Clinicopathologic Features of Parathyroid Lipoadenoma

Parathyroid lipoadenoma (PLA) is a rare cause of primary hyperparathyroidism and is over 50% adipose tissue, which complicates preoperative localization. We aimed to describe clinical and imaging features of PLA in this case series. We retrospectively reviewed 4 patients with pathologically confirmed PLA and biochemical evidence of primary hyperparathyroidism. All patients exhibited elevated PTH and upper-normal to elevated calcium levels. PLAs demonstrated hyperechogenicity on ultrasonography, fat-equivalent attenuation on CT, and increased uptake on sestamibi SPECT/CT. Surgical excision resulted in notable intraoperative PTH decline and postoperative biochemical cure. Pathology confirmed >50% stromal fat in all cases. In conclusion, PLA presents unique diagnostic challenges because of its imaging characteristics. Awareness of these features and a multimodal imaging approach are key to accurate localization and successful surgical management.