Results of a Multidisciplinary Strategy for Management of Mediastinal Parathyroid Adenoma as a Cause of Persistent Primary Hyperparathyroidism (original) (raw)
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The results of surgery for mediastinal parathyroid tumors: a comparative study of 63 patients
Langenbeck's Archives of Surgery, 2010
Purpose Parathyroidectomy for ectopic mediastinal hyperfunctioning glands could be performed by transcervical approach, sternotomy, thoracotomy, and recently by thoracoscopic and mediastinoscopic approaches. This study was aimed to analyze the results of traditional and videoassisted parathyroidectomy for mediastinal benign hyperfunctioning glands. Methods Fifty-one upper mediastinal exploration by a conventional cervicotomy, 12 by video-assisted approaches (two thoracoscopy and 10 transcervical mediastinoscopy) and six by sternotomy were performed in 63 patients with primary hyperparathyroidism. Results Video-assisted and sternotomic parathyroid explorations achieved biochemical cure in all cases; following conventional transcervical mediastinal exploration, a persistent hyperparathyroidism occurred in 11.8% of patients, who were subsequently cured by sternotomic approach. No complications occurred after video-assisted parathyroidectomy, while an overall morbidity rate of 50% and 10% was found after sternotomic and conventional cervicotomic approaches. Postoperative pain and hospital stay were significantly increased following sternotomy; patient's subjective cosmetic satisfaction was significantly higher after video-assisted and conventional cervicotomic approaches.
Mediastinal parathyroid adenoma causing primary hyperparathyroidism
JPMA. The Journal of the Pakistan Medical Association, 2007
An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recurrent primary hyperparathyroidism (PHPT) and is recognized as an important cause of failed primary neck exploration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first exploration whereas in the 3rd case, it was successfully removed with mediastinal exploration after 2 failed neck explorations. In established cases of PHPT with equivocal preoperative localization studies or negative neck explorations, an ectopically placed parathyroid adenoma should be considered and once localized, should be surgically removed for cure.
Radiofrequency Ablation of Parathyroid Adenomas: Safety and Efficacy in a Study of 10 Patients
Indian Journal of Endocrinology and Metabolism, 2020
Original Article introduction Primary hyperparathyroidism is associated with elevated levels of serum calcium because of over secretion of parathormone. [1] The incidence of primary hyperparathyroidism in the USA has been reported to range from 0.7% in the general population up to 3% in postmenopausal women. [2-4] Parathyroid adenomas are the most common cause for primary hyperparathyroidism with an incidence of 80-85%. [5] Standard method of treatment for a parathyroid adenomas causing hyperparathyroidism is parathyroidectomy. [6] Previous studies have shown that parathyroidectomy for primary hyperparathyroidism is curative in greater than 95% of cases when performed by an experienced surgeon. [7] Although it is curative, the need for general anesthesia in patients having comorbidities may not always make them suitable to undergo surgical procedure. Also, the consequences of having a post-surgical scar and possible risk for lifelong hypoparathyroidism may make some patients not wanting to undergo surgery. A few authors do endorse use of minimally invasive parathyroid surgery using local instead of general anesthesia. [8-10] However, limitations including lack of compliance in some patients, inadequate skill, concomitant thyroiditis, recurrent laryngeal nerve palsy, wound infection, intraoperative hemorrhage and a resultant conversion of procedure to general anesthesia in 10% of cases, needs consideration. [11,12] Hence in such patients and patients with comorbidities, minimally invasive non-surgical treatment methods serve a viable option. Use of non-surgical techniques of ethanol ablation and radiofrequency ablation for treatment of parathyroid adenoma have shown to yield good clinical results. [13-15] Radiofrequency ablation (RFA) is a minimally invasive technique that has been used to treat benign nodules of the thyroid [16] and para-thyroid glands. [17,18] In 2017, the Korean Purpose: To evaluate safety and effectiveness of ultrasound-guided percutaneous radiofrequency ablation of parathyroid adenoma in surgically unfit patients with hypercalcemia because of hyperparathyroidism. Materials and Methods: A retrospective review of hospital records from Jan 2012 to Dec 2018 revealed 10 patients, who had undergone ablation for solitary parathyroid adenoma. All 10 patients suffered from hyperparathyroidism because of parathyroid adenoma, resulting in hypercalcemia. These patients were surgically unfit because of comorbidities. Pre-ablation serum calcium and serum parathormone levels were measured and compared with the levels after the ablation. Results: Mean serum calcium level decreased significantly from 2.81 ± 0.17 mmol/L pre-ablation to 2.42 ± 0.17 mmol/L 72 h after ablation and parathyroid hormone levels became normal in all patients within 7 days. Seven patients remained normo-calcaemic at 6 months follow-up with no signs and symptoms of hyperparathyroidism. One patient with pancreatitis died after 15 days because of pre-existing multi-organ failure. Two patients were lost to follow-up before 6 months. Conclusion: Radiofrequency ablation of parathyroid adenoma is a safe and effective alternate treatment method for symptomatic hypercalcemia in surgically unfit patients suffering from primary hyperparathyroidism because of parathyroid adenoma.
Open Journal of Thoracic Surgery, 2017
Introduction: Primary hyperparathyroidism is a disease commonly caused by a single parathyroid adenoma in 80%-85% of cases, and is less frequently caused by parathyroid hyperplasia. In approximately 2% of cases, the ectopic parathyroid adenoma is located within the mediastinum. Safely targeted parathyroidectomy is the gold standard procedure for surgical management of primary hyperparathyroidism. We reviewed our surgical experience using video-assisted thoracic surgery and a robotic technique for surgical resection of mediastinal parathyroid adenoma, caused by primary hyperparathyroidism. Materials and Methods: From July 2010 to September 2016, six consecutive patients with symptomatic primary hyperparathyroidism were evaluated with neck ultrasound computed tomography (CT), technetium-99 sestamibi scintigraphy, and selective venous sampling with a measurement of parathyroid hormone levels. Four patients underwent video-assisted thoracic parathyroidectomy and two patients had robotic-assisted parathyroidectomy. Results: In six patients, there were four women and two men with a mean age of 47.5 years (ranging from 31-60 years). The mediastinal parathyroid adenomas were successfully localized by preoperative imaging studies in five patients. Only in one patient, we were unable to localize the parathyroid adenoma. All parathyroid adenomas were successfully resected without any complications. Conclusions: We found that minimally invasive mediastinal parathyroidectomy is promising, safe, and effective in a selected group of patients, as well as providing superior cosmetic results and a short hospital stay.
Case Report Mediastinal Parathyroid Adenoma
2015
An ectopically placed parathyroid adenoma in the anterior mediastinum is a rare cause of persistent or recur-rent primary hyperparathyroidism (PHPT) and is recog-nized as an important cause of failed primary neck explo-ration. We encountered 3 such cases amongst 70 surgically treated patients with PHPT (4.3%) over a 20-year period. In 2 cases, the offending adenoma could be removed at first exploration whereas in the 3rd case, it was successfully removed with mediastinal exploration after 2 failed neck explorations. In established cases of PHPT with equivocal preoperative localization studies or negative neck explo-rations, an ectopically placed parathyroid adenoma should be considered and once localized, should be surgically removed for cure.
Localization and management of mediastinal parathyroid adenoma – a case report
IMC journal of medical science, 2022
Ectopic parathyroid adenoma sometimes poses diagnostic challenge and can be a cause of persistent and recurrent primary hyperparathyroidism. Anterior mediastinum is one of the locations for ectopic parathyroid adenoma. Surgical excision is the only cure and for successful surgery, pre-operative localization is crucial. Chance of failed surgery is being increased without prior localization of the ectopic gland. The combination of single photon emission computed tomography (SPECT) and computed tomography (CT) has got high sensitivity for accurate localization of ectopic parathyroid. On the other hand, with accurate localization surgical outcome is excellent. Here we report, successful localization and management of a case of primary hyperparathyroidism due to adenoma in anterior mediastinum in 47-year-old man.
Management of a Parathyroid Adenoma With Radiofrequency Ablation: A Case Report
Iranian Red Crescent Medical Journal, 2016
Introduction: The standard treatment for symptomatic primary hyperparathyroidism due to parathyroid adenoma is surgery, but in patients who are not good candidates for surgery, other treatment modalities including ethanol ablation, laser ablation, ultrasound wave ablation, and radiofrequency ablation are used. We describe a patient with multiple medical problems and a parathyroid adenoma who was treated with radiofrequency ablation. Case Presentation: A 47-year-old patient was referred to our hospital (Namazi hospital, Shiraz, Iran) in April, 2015 with intracranial hemorrhage, as well as high serum calcium and PTH (parathyroid hormone) levels (12.1 mg/dL and 1062 pg/mL, respectively), who had a parathyroid adenoma. Radiofrequency ablation was performed for the patient after he was stabilized, and three days later, his serum calcium and PTH levels decreased to 8.9 mg/dL and 38 pg/mL, respectively, and there was abnormal uptake according to the post-ablation parathyroid scan. The patient was followed for 12 months in our endocrine clinic, during which time he was in good general condition, with normal serum calcium, phosphate, and parathyroid hormone levels. Conclusions: Radiofrequency ablation may be used successfully in the treatment of parathyroid adenoma when a patient cannot tolerate surgery.
World Journal of Surgery, 2011
Background Thoracoscopic surgery has replaced conventional sternotomy or thoracotomy for resection of mediastinal parathyroid lesions. We review our experience with this type of surgery with reference to selection of the appropriate approach and the pitfalls of lesion localization before and during surgery. Methods During a 14-year period, we treated 14 patients with hyperparathyroidism, in whom a mediastinal lesion had been localized preoperatively by sestamibi scan. Primary hyperparathyroidism was present in 12 patients (single adenoma in 11, associated with MEN 1 in one) and secondary hyperparathyroidism in 2. Thoracoscopic procedures were performed by the three-port method. Results The thoracoscopic procedure was successful in eight patients who were shown preoperatively to have a deep-seated (5 anterior, 3 middle) mediastinal lesions. Intraoperative visual confirmation of parathyroid adenoma was difficult only in a 19-year-old patient with a tumor embedded in the thymus, necessitating partial thymectomy. One of the eight mediastinal lesions resected thoracoscopically was a sestamibi-positive thymoma. Secondary hyperparathyroidism recurred 4 years after thoracoscopic mediastinal parathyroidectomy in one patient, necessitating additional thoracoscopic removal of this supernumerary lesion. However, seven patients with mediastinal parathyroid lesions localized at the aortic arch or upper region were treated successfully via a cervical approach. None of the patients suffered any surgical complications. Conclusions Thoracoscopic surgery is safe and feasible for resection of deep mediastinal parathyroid lesions. Such lesions localized preoperatively at the aortic arch or upper region can be treated via a cervical approach. Preoperative sestamibi scan can sometimes give a false-positive result in cases of concurrent thymoma.