Mediastinal parathyroid adenoma causing primary hyperparathyroidism (original) (raw)
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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.
Annals of Surgery, 1992
Persistent primary hyperparathyroidism due to mediastinal parathyroid adenoma was effectively treated by either angiographic ablation or median sternotomy in this study of49 patients managed at the National Institutes of Health since 1977. Each patient presented here with symptomatic persistent primary hyperparathyroidism after failed initial surgical procedures done at other institutions. Each patient underwent extensive parathyroid localization procedures, including selective angiography, and most had a parathyroid adenoma localized to the mediastinum. Angiographic ablation, the deliberate injection of large doses of contrast material into the artery that selectively perfuses the adenoma, was initially successful in 22 of 30 procedures (73%) in 27 patients. Long-term control of persistent primary hyperparathyroidism was achieved in 17 of 27 patients (63%) by angiographic ablation. Each unsuccessful ablation could be easily salvaged by surgical resection. Surgical resection of the parathyroid adenoma by median sternotomy achieved immediate success in 24 of 24 procedures (p2 < 0.02 versus ablation), and long-term cure in 23 of 23 evaluable patients (P2 < 0.001 versus ablation). However, ablation did have benefits for the patients in whom it was successfully performed. It was associated with a significantly shorter hospital stay (median, 6 days versus 9 days for sternotomy, P2 < 0.003), much less pain, and easier recuperation. Complications of each procedure were transient and similar in both groups. Operative resection is the most effective single means to eradicate mediastinal parathyroid adenoma; however, angiographic ablation can provide similar longterm control of hyperparathyroidism in 63% of patients with less pain and shorter convalescence than that seen in patients after median sternotomy. Our results suggest that angiographic ablation should be attempted as the initial procedure for patients with persistent primary hyperparathyroidism caused by an an-giographicaHly identified mediastinal parathyroid adenoma. Operation can be reserved for those who fail ablation.
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.
Radioguided parathyroidectomy for hyperparathyroidism in the reoperative neck
Surgery, 2009
Background-The purpose of this study was to determine if radioguided parathyroidectomy (RGP) is effective for hyperparathyroidism (HPT) in the reoperative neck. Methods-We retrospectively reviewed all patients with HPT and a history of neck surgery who underwent RGP over a 7-year period. Data are reported as mean ± SEM. Results-We identified 110 patients with primary (n=94), secondary (n=7), or tertiary (n=9) HPT who underwent 138 previous neck operations. The average hospital stay was 0.6 ± 0.1 days. The in and ex vivo counts obtained with the gamma probe were 310 ± 26 and 130 ± 13, respectively. The ex vivo percentage of background was 69 ± 9%, and virtually all resected parathyroids had ex vivo counts ≥ 20%. Following RGP, 96% of patients were cured, and 4.5% experienced complications (all transient). Cure rates after RGP significantly decreased as the number of previous neck surgeries increased (P=0.002). Additionally, reoperative neck patients with single adenomas were more likely to experience cure than patients with hyperplasia (P=0.02). Conclusions-These results illustrate that RGP is valuable adjunct in the reoperative neck. In addition, RGP allows similar lengths of stay, efficacy, and complication rates as those reported for patients undergoing initial parathyroidectomy. Hyperparathyroidism (HPT) results from the excess secretion of parathyroid hormone (PTH) by at least one hyperfunctioning parathyroid gland usually leading to hypercalcemia. In patients with HPT who meet the indications for parathyroidectomy, initial surgery is associated with high cure rates and minimal morbidity for primary, secondary, and tertiary HPT (1-3). Nonetheless, persistent or recurrent disease develops in a subset of these patients and requires re-exploration. Failure of initial surgery is frequently due to an incomplete or inadequate resection because the diseased parathyroid gland(s) was not identified or a supernumerary gland was present (4, 5). These missed glands are often in an ectopic location or in the normal anatomic position. Failure to identify multiple abnormal glands in patients with a presumed adenoma also occurs and leads to persistent HPT. In addition, patients may present for an initial parathyroidectomy with a history of prior neck surgery related to thyroid, carotid, spine, malignant, or tracheal disease.
A surgical challange for primary hyperparathyroidism: Intravagal parathyroid adenoma
A missed parathroid adenomas are the most common cause of surgical failure in persistent primary hyperparathyroidic patients. Abnormalities in the normal migration of the parathyroid glands during embryological development of the head and neck may result in considerable variability in the location of parathyroid tissue. Imaging studies were crucial in localizing the neoplasms in these patients. It is important to develop a strategy to systematically locate these glands either by preoperative investigations or surgical exploration. We describe a patient with persistent primary hyperparathyroidism who underwent three unsuccessful surgical procedures due to an intravagal parathyroid adenoma.
Primary Hyperparathyroidism Through an Ectopic Parathyroid Adenoma
Chirurgia, 2016
INTRODUCTION Parathyroid glands, usually four, are localized at the anterior cervical level, in several positions, on the posterior side of the thyroid gland. Parathyroid glands participate to calcium level regulations by producing the parathormone as a response to hypocalcemia. Hyperparathyroidism is defined as the excess secretion of the parathormone. MATERIAL AND METHOD We present the case of 48 year-old women, admitted with intense bone pain, headache and dizziness. Imaging studies performed identified a small nodule localized in the anterior mediastinum. This nodule was positive for high levels of tracer fixation. Surgery was performed and the nodule was identified as a small parathyroid adenoma. RESULTS AND DISCUSSIONS The outcome of the surgical intervention was favorable, without any postoperative complications. We suggest for the imaging diagnostic procedure to include: ultrasonography, scintigraphy, computed tomography, MRI. Using nuclear medicine, the sensibility for the ...
Intrathyroid Parathyroid Adenoma in Primary Hyperparathyroidism: Can It Be Predicted Preoperatively?
World Journal of Surgery, 2007
Introduction: The role of cervical ultrasonography (US)-guided surgery for intrathyroid parathyroid adenoma in primary hyperparathyroidism is rarely reported. The aim of this study was to elucidate the role of cervical US in identifying this entity. Methods: From 1996 to 2003, cervical explorations were performed in 178 patients (mean age 57 years) with primary hyperparathyroidism. High-resolution cervical US was performed in all of the patients. Patients' characteristics were reviewed to identify predictive factors for intrathyroid adenoma. Results: Cervical US identified abnormal parathyroid glands in 163 of 178 patients, with a positive predictive value (PPV) of 100%. Six patients (3.4%) were found to have intrathyroid parathyroid adenomas (two in the superior parathyroid and four in the inferior parathyroid). Cervical US predicted this anomaly in four of six patients (67%) in whom the thyroid gland was not nodular and allowed total enucleation of the adenoma to be performed in three and subtotal thyroid loboisthmectomy in three; these operations were performed uneventfully and rapidly. The PPV in this anomaly was 80%. Thirteen patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at the time of the last clinic visit, with follow-up varying from 12 to 96 months. On multivariable analysis, no factor predicted intrathyroid localization of parathyroid adenoma. Conclusions: The PPV of high-resolution cervical US for identifying an abnormal parathyroid gland was 100% in this series. It was 80% for predicting intrathyroid localization of the adenoma. This method allows us to shorten the operating time by guiding the exploration immediately toward the thyroid gland.