The Ectopic Parathyroid Adenoma

Abstract

The added cost of protracted or failed cervical exploration nearly neutralized the costs of a routine preoperative localization with technetium Tc 99m sestamibi and ultrasound scans.

Gamma probe-assisted excision of an ectopic parathyroid adenoma located within the thymus: case report and review of the literature

“…An alternative therapeutic approach, in patients who cannot be operated, is the angioablation with injection of a hyperosmolar agent [ 30 ]. Since there are reports of failed surgery in ectopic adenomas without the use of gamma probe the latter becomes the mainstay for exact adenoma detection [ 2 ]. Usually the cause of a failed primary exploration is an occult double adenoma which necessitates the combination of gamma probe and QPTH in the intraoperative detection of the ectopic parathyroid adenoma.…”

“…Another report emphasizes that the number of patients with persistent hyperparathyroidism after surgery increased significantly from 0.8% to 5.0% without measuring intra-operative QPTH [ 36 ]. Since a failed surgery involves large cost effects, a meticulous preoperative imaging with ultrasound, 99m Tc sestamibi, and MRI or CT is mandatory for the primary and moreover the revision surgery [ 2 ].…”

“…20% of these present as ectopic parathyroid glands during embryogenesis and the majority of them are located near or within the thymus due to the common origin of the thymus and the inferior parathyroid glands from the third bronchial pouch [ 1 ]. Possible positions of the embryologically ectopic adenoma is the deep anterior mediastinum, the aortopulmonary window, the posterior mediastinum, or within the substance of the thyroid gland [ 2 ]. However, paraesophageal and retroesophageal parathyroid tumors are not considered ectopic since they have normal blood supply from a branch of the inferior thyroid artery and they arise from superior parathyroid glands [ 3 ].…”

“…Preoperative diagnostic methods for the localization of primary parathyroid adenomas have their advocates and opponents. Many studies have confirmed the efficacy of Technetium-99 m ( 99m Tc) sestamibi scans in identifying mediastinal adenomas [ 2 ]. It was first designed and in the last 20 years clinically implemented by Coackley et al [ 4 ].…”

Preoperative Localizing Studies for Initial Parathyroidectomy in MEN1 Syndrome: Is There Any Benefit?

“…These ectopic and/or supernumerary parathyroid glands are most commonly intrathymic [25–27]. The rate of ectopic parathyroid gland not in the thymus in pHPT is ~8–10% [28, 29], and most of these glands can be removed via a cervical approach. The definition of ectopic parathyroid gland in this study was based on the impression of the surgeons.…”