Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look?

Abstract

Purpose: Preoperative localization studies for parathyroid adenomas are very essential to perform minimal invasive parathyroidectomy (MIP) with decreased operative time and potential complications. Although most of these studies based on radiological imaging, intraoperative assessment provides the most accurate anatomical description of the location of parathyroid adenomas. In this study, we aim to evaluate the surgical variations of locations of parathyroid adenomas in patients performed parathyroid surgery for primary hyperpara thyroidism (PHPT). Materials and methods:Between January 2010 and December 2013, 243 patients (201 women/42 men) who underwent parathyroid surgery due to PHPT were included. A total of 254 parathyroid adenomas were detected. Demographic features, preoperative workup, surgical approach, types of procedures and postoperative complications were noted. Locations of parathyroid adenomas were recorded from operative notes. Statistical analysis was performed using ttest and chisquare. continuous data are expressed as mean ± standard deviation. Results:With regard to the most frequently observed, location of adenomas were as follows; right inferior (n = 89, 37.7%), left inferior (n = 78, 33%), right superior (n = 44, 18.6%), left superior (n = 25, 10.5%) and ectopic locations (n = 18). Ectopic adenomas were mostly located in the thymus (n = 9) and intrathyroidal tissue (n = 6) at a rate of 83%. Postoperative hypocalcemia (11%) was mostly seen in those with parathyroid adenoma located around the inferior lobes of the thyroid (86%) and undergoing bilateral neck exploration (75%). Conclusion:The most of the parathyroid adenomas were found in orthotopic position and located around the lower pole of the thyroid gland. Ectopic adenomas were mostly located in thymus or intrathyroidal. Postoperative hypocalcemia was also higher in those with parathyroid adenoma located around the inferior lobe of the thyroid.

Surgery for nonlocalizing hyperparathyroidism in high volume center

“…12 None of these papers analyzed locations of adenomas specifically in patients with negative preoperative imaging. We observed a non-significant finding of right inferior to be the most common location of a single adenoma in patients with both localizing and nonlocalizing imaging, corresponding with previous study by Yazici et al 9 Our data reflecting higher rates of disease involving more than one gland (double adenomas, MGD) in patients with nonlocalizing scans correlates with previous research. 15,16 This evidence suggests that neck exploration for parathyroidectomy in patients with PHPT and negative preoperative imaging should be organized.…”

“…Yazici et al have described the most common surgical locations for adenomas in 243 patients with PHPT, with a predilection near the inferior lobe of the thyroid (70%), especially the right inferior location (38%). 9 Marzouki et al found the most prevalent location for adenoma in their study of 147 patients was the left inferior parathyroid gland (41%), and that pathologic glands were more likely to be inferior (74%). 10 A classification system known as the Perrier nomenclature has been developed to describe parathyroid adenoma location that has seven categories (Type A-G), however, it does not indicate laterality.…”

“…It was originally felt that retrothyroid locations may obscure sestamibi and ultrasound results, but this was not elucidated in our findings. Yazici et al have described the most common surgical locations for adenomas in 243 patients with PHPT, with a predilection near the inferior lobe of the thyroid (70%), especially the right inferior location (38%) 9 . Marzouki et al found the most prevalent location for adenoma in their study of 147 patients was the left inferior parathyroid gland (41%), and that pathologic glands were more likely to be inferior (74%) 10 .…”

“…Although standard imaging allows identification of the adenoma in the majority of patients, a sizable minority of patients still have nonlocalizing studies. Previous research has examined the locations of parathyroid adenomas in patients with PHPT and localization on preoperative scans 9–12 . While small series have reported higher incidences of ectopic glands in nonlocalized disease, this has not been reported in any large series 13 .…”

“…Previous research has examined the locations of parathyroid adenomas in patients with PHPT and localization on preoperative scans. [9][10][11][12] While small series have reported higher incidences of ectopic glands in nonlocalized disease, this has not been reported in any large series. 13 In this study, we investigated patients with PHPT who underwent parathyroidectomy and stratified them into groups based on preoperative localization status.…”