Background: Parathyroid adenoma is the most common cause of hypercalcemia and rarely leads to a hypercalcemic crisis, which is an unusual endocrine emergency that requires timely surgical excision. Case presentation: A 67-year-old male was admitted to the ER of the Euroclinic Hospital, Athens, Greece, because of elevated calcium levels and a palpable right-sided neck mass, which were accompanied by symptoms of nausea, drowsiness, and weakness for six months that increased prior to our evaluation. A gradual creatinine elevation and decreasing mental state were observed as well. The initial laboratory investigation identified severely elevated serum calcium (3.6 mmol/L) levels consistent with a hypercalcemic crisis (HC) and parathyroid hormone PTH (47.6 pmol/L) due to primary hyperparathyroidism. Neck ultrasonography (USG) identified a large, well-shaped cystic mass in the right thyroid lobe. With a serum calcium concentration of 19.5 mg/dL and a PTH of 225.3 pmol/L, the patient underwent partial parathyroidectomy and total thyroidectomy, which decreased serum calcium and PTH to 2.5 mmol/L and 1.93 pmol/L, respectively. Histology revealed a giant intrathyroidal cystic parathyroid adenoma, which was responsible for the hypercalcemic crisis. Postoperatively, the patient developed severe biochemical and clinical hypocalcemia, with calcium concentrations as low as 1.65 mmol/L, consistent with hungry bone syndrome (HBS), which was treated with high doses of intravenous calcium gluconate and oral alfacalcidol, and a slow recovery of serum calcium. After discharge, parathyroid function recovered, and symptomatology resolved entirely in more than one month. Discussion/conclusions: We present a case involving an exceptionally large intrathyroidal parathyroid adenoma that is characterized by clinical manifestations that mimic malignancy. The identification and treatment of such tumors is challenging and requires careful preoperative evaluation and postoperative care for the risk of hungry bone syndrome.

Background and Clinical Significance: Metastatic carcinoma of the lacrimal sac originating from primary nasopharyngeal carcinoma (NPC) is a rare entity, usually presenting with chronic, unilateral epiphora. Case Presentation: A 55-year-old male patient presented with symptoms of chronic persistent dacryocystitis of the left eye for a year. His history revealed a non-keratinizing NPC diagnosed 5 years earlier, which was treated with combined radiotherapy (RT) and chemotherapy (CMT). Following CT and MRI scans, a mass was identified at the left lacrimal sac suggestive of a neoplasm in that region. The patient underwent endoscopic dacryocystorhinostomy (DCR), with tissue samples taken for biopsy. The histopathological diagnosis revealed a metastatic carcinoma of the lacrimal sac originating from the nasopharynx. The postoperative course was uneventful. However, a follow-up positron emission tomography-computed tomography (PET-CT) scan showed a hypermetabolic lesion in the left orbital cavity, infiltration of the lacrimal sac, hypermetabolic lateral cervical lymph nodes (IIA-IIB), and a hypermetabolic parotid lymph node. The patient is currently receiving combined CMT and immunotherapy (IMT) and is scheduled to receive RT thereafter. Conclusions: The non-specific symptomatology of the disease might be a reason for delayed diagnosis. Early recognition requires a high index of suspicion, while therapy mainly focuses on RT, CMT, IMT, and rarely on surgical approaches. A multidisciplinary approach and coordination are indispensable for the best possible treatment outcome.

Introduction: Hearing loss and cognitive impairment are among the most common chronic conditions of aging, and a growing body of evidence links the two. The 2020 and 2024 Lancet Commissions identified midlife hearing loss as one of the largest potentially modifiable risk factors for dementia, raising the possibility that auditory rehabilitation could help preserve cognition. Methods: This narrative review provides a lifespan perspective by summarizing current evidence on the relationship between hearing loss and cognitive decline, the cognitive domains most affected, and the mechanisms proposed to explain the association, including the cognitive load, common cause, cascade, and overdiagnosis hypotheses, together with their neurobiological correlates. Results: We then examine the effect of auditory interventions on cognition in adults, considering hearing aids and cochlear implants separately, and discuss landmark trials such as ACHIEVE, which suggest that cognitive benefits may be greatest in older adults at increased risk of decline. Finally, we address the distinct situation of children, in whom early auditory deprivation may shape the development of working memory and executive function and in whom the timely fitting of hearing devices is critical. Conclusions: Overall, the evidence supports hearing loss as a modifiable contributor to cognitive decline and highlights early detection and rehabilitation as promising, though not universally effective, strategies for protecting cognitive health.