Parathyromatose : une cause rare d’hyperparathyroïdie récidivante

Achour, I.; Châabouni, M.; Chakroun, A.; Guermazi, F.; Hammami, B.; Ghorbel, Abdel Mounem

doi:10.1016/j.revmed.2016.03.005

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Treatment is the surgical removal of all foci. However, berry picking surgery would be a failure for complete excision; thus, an extensive surgery is required with resection of multiple parathyromatosis foci and clearance of the central neck compartment ( 36 ). In this case, the extensive surgery was performed, and no recurrence was present on the postoperative 10 months.…”

Section: Discussionmentioning

confidence: 99%

Recurrent renal secondary hyperparathyroidism caused by supernumerary mediastinal parathyroid gland and parathyromatosis: A case report

Cheng

et al. 2023

Front. Surg.

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BackgroundSurgical parathyroidectomy (PTX) is necessary for patients with severe and progressive secondary hyperparathyroidism (SHPT) refractory to medical treatment. Recurrence of SHPT after PTX is a serious clinical problem. Both supernumerary mediastinal parathyroid gland and parathyromatosis are the rare causes of recurrent renal SHPT. We report a rare case of recurrent renal SHPT due to supernumerary mediastinal parathyroid gland and parathyromatosis.Case presentationA 53-year-old man underwent total parathyroidectomy with autotransplantation due to the drug-refractory SHPT 17 years ago. In the last 11 months, the patient experienced symptoms including bone pain and skin itch, and the serum intact parathyroid hormone (iPTH) level elevated to 1,587 pg/ml. Ultrasound detected two hypoechoic lesions located at the dorsal area of right lobe of the thyroid gland, and both lesions presented as characteristics of hyperparathyroidism in contrast-enhanced ultrasound. 99mTc-MIBI/SPECT detected a nodule in the mediastinum. A reoperation involved a cervicotomy for excising parathyromatosis lesions and the surrounding tissue and a thoracoscopic surgery for resecting a mediastinal parathyroid gland. According to a histological examination, two lesions behind the right thyroid lobe and one lesion in the central region had been defined as parathyromatosis. A nodule in the mediastinum was consistent with hyperplastic parathyroid. The patient remained well for 10 months with alleviated symptoms and stabilized iPTH levels in the range of 123–201 pg/ml.ConclusionAlthough rare, recurrent SHPT may be caused by a coexistence of both supernumerary parathyroid glands and parathyromatosis, which should receive more attention. The combination of imaging modalities is important for reoperative locations of parathyroid lesions. To successfully treat parathyromatosis, all the lesions and the surrounding tissue must be excised. Thoracoscopic surgery is a reliable and safe approach for the resection of ectopic mediastinal parathyroid glands.

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Section: Discussionmentioning

confidence: 99%

Recurrent renal secondary hyperparathyroidism caused by supernumerary mediastinal parathyroid gland and parathyromatosis: A case report

Cheng

et al. 2023

Front. Surg.

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“…По результатам зарубежных авторов его чувствительность и специфичность очень высоки, достигают 91% и 100%, соответственно [12].…”

Section: клинический случайunclassified

“…Ранее в профессиональной литературе обсуждал-ся вопрос о возможности развития паратироматоза при множественных пункциях аденом ОЩЖ, однако ни в одном из исследований не выявлено развитие па-ратироматоза после пункционной биопсии аденом ОЩЖ [12]. Среди неблагоприятных последствий пунк-ционной биопсии ОЩЖ с целью определения уровня ПТГ в смыве ряд авторов выделяет местные изменения (боль, гиперемию, локальное воспаление, кровоизли-яние и др.)…”

Section: клинический случайunclassified

Role of parathyroid hormone measurement in fine-needle aspiration biopsy washout in diagnosis and treatment of primary hyperparathyroidism

et al. 2018

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Остеопороз и остеопатии / Osteoporosis and Bone Diseases | 108 CASE REPORT АКТУАЛЬНОСТЬПервичный гиперпаратиреоз (ПГПТ) -первичная, т. е. не спровоцированная пониженным уровнем каль-ция в крови, гиперпродукция паратгормона (ПТГ), кото-рая приводит к нарушению гомеостаза кальция.Заболеваемость ПГПТ составляет около 20 случаев на 100 тыс. населения в год; в течение последних лет на-блюдается ее неуклонный рост в связи с повышением и информативности и доступности методов диагностики ПГПТ. Распространенность ПГПТ в популяции составля-ет около 1%, увеличивается с возрастом и достигает 2% Сложности в топической диагностике первичного гиперпартиреоза в ряде случае обусловлены вариабельностью расположения околощитовидных желез. Наиболее часто верхние околощитовидные железы обнаруживаются по за-днемедиальной поверхности правой и левой долей щитовидной железы (верхняя треть доли), хотя встречаются и на уровне бифуркации общей сонной артерии, за глоткой и пищеводом, и интратиреоидно (1%). Расположение нижних околощитовидных желез более вариабельно: по боковой или задней поверхности, или ниже нижнего полюса щитовидной железы на расстоянии 0,2-1,5 см, в рогах тимуса, в переднем или заднем средостении, интратиреоид-но (1-2%). Это объясняется сложным и продолжительным характером миграции зачатка из III-IV жаберного кармана в ходе эмбриогенеза. Топическая диагностика при первичном гиперпаратиреозе опирается на данные УЗИ органов шеи, сцинтиграфии с технетрилом, мультиспиральной компьтерной томографии органов шеи и средостения. При со-четании многоузлового зоба и интратиреоидного расположения околощитовидной железы могут возникнуть допол-нительные сложности в верификации различных узлов (узлы щитовидной железы или околощитовидные железы). В настоящей статье обсуждается два клинических случая интратиреоидного расположения околощитовидных желез. Показан алгоритм топического подтверждения диагноза. Определение уровня паратгормона в пунктате из подозри-тельных образований, которые могут представлять собой интратиреоидные околощитовидные железы или узлы щи-товидной железы, поможет избежать диагностических ошибок. In this article, we discuss difficulties in parathyroid localization modalities in diagnosis of primary hyperparathyroidism. Most often, superior parathyroid glands are located on the posteromedial surface of the right and left lobes of the thyroid gland, however, they also could be found at the carotid bifurcation, behind pharynx and esophagus, as well as inside thyroid gland. Location of the inferior parathyroid glands is more variable: on the side or back surface, or below the lower pole of the thyroid gland, as well as in thymus, posterior or anterior mediastinum, or inside thyroid. Localization modalities of primary hyperparathyroidism are based on neck ultrasonography, scintigraphy with sestamibi, computed tomography of neck and mediastinum. In cases with combination of multinodal goitre and an intrathyroid location of the parathyroid gland, there might be additional difficulties in verification of various patterns (th...

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Cancer of an ectopic parathyroid gland: from diagnosis to treatment (clinical case)

et al. 2021

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The article presents a clinical case of a prolonged course of gastrointestinal ulcer disease, followed by dysphagia. During the examination, severe hyperparathyroidism was revealed, which subsequently prompted a diagnostic search for a parathyroid adenoma, which is the cause of hyperathyroidism in 8085% of cases. With instrumental methods of research, the cause of the main complaint is dysphagia, a formation in the posterior upper mediastinum up to 5 cm, compressing the esophagus. With transoesophageal aspiration biopsy (EUS-TYPE). The cytological picture is similar to the thyroid epithelium with part of the oncocytic differentiation. In an immunological study, lavage for parathyroid hormone showed high expression. Scintigraphy with Tc-99m pertechnetate revealed the exact topic of the formation of the parathyroid gland in the posterior mediastinum an atypical location. Surgical treatment was performed in the amount of thoracoscopic removal of the mediastinal tumor. The radical nature of the surgical intervention was confirmed by laboratory. Serum PTH levels decreased significantly. Upon receipt of the morphological conclusion, reliable data on malignant damage to the parathyroid gland were obtained. Subsequent treatment of the patient consisted in the correction of severe hypercalcemia in the postoperative period by prescribing denosumab, which led to the stabilization of the patients condition.

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Parathyromatose : une cause rare d’hyperparathyroïdie récidivante

Cited by 4 publications

References 9 publications

Recurrent renal secondary hyperparathyroidism caused by supernumerary mediastinal parathyroid gland and parathyromatosis: A case report

Recurrent renal secondary hyperparathyroidism caused by supernumerary mediastinal parathyroid gland and parathyromatosis: A case report

Role of parathyroid hormone measurement in fine-needle aspiration biopsy washout in diagnosis and treatment of primary hyperparathyroidism

Cancer of an ectopic parathyroid gland: from diagnosis to treatment (clinical case)

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