World Journal of Endocrine Surgery

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VOLUME 12 , ISSUE 3 ( September-December, 2020 ) > List of Articles

CASE REPORT

Undescended Parathyroid Adenomas: A Leading Cause of Persistent Primary Hyperparathyroidism

Ankita Roy, Muhammad H Khan, Joseph Frazzetta, Adam S Kabaker, Steven De Jong

Keywords : Case report, Minimally invasive parathyroidectomy, Primary hyperparathyroidism, Undescended parathyroid adenoma

Citation Information : Roy A, Khan MH, Frazzetta J, Kabaker AS, De Jong S. Undescended Parathyroid Adenomas: A Leading Cause of Persistent Primary Hyperparathyroidism. World J Endoc Surg 2020; 12 (3):132-135.

DOI: 10.5005/jp-journals-10002-1306

License: CC BY-NC 4.0

Published Online: 00-12-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: We present the case of a 64-year-old man with symptomatic primary hyperparathyroidism (PHPT) who was found to have a rare undescended parathyroid adenoma (UPA). While UPAs have a low prevalence, they are challenging cases for endocrine surgeons. We include background information and a summary of the literature of UPAs and presentation, workup, management, and outcomes of this patient. Introduction: Undescended parathyroid adenomas are rare ectopic glands that are found above the upper pole of the thyroid gland.1 They are difficult to localize on routine imaging and require strategic preoperative planning to determine the surgical approach. Case description: A 64-year-old man presented to our tertiary care center with symptomatic PHPT. Sestamibi with SPECT/CT showed a 1.4 cm focus of uptake in the left upper neck that was suspicious for an ectopic UPA. Conclusion: With appropriate preoperative imaging and planning, the patient was able to undergo curative minimally invasive parathyroidectomy. The patient had an uncomplicated postoperative recovery with resolution of symptoms and normalization of calcium and parathyroid hormone (PTH) levels. Clinical significance: Undescended parathyroid adenomas are difficult to locate and are a leading cause of persistent PHPT, failed cervical explorations, and patient morbidity.2 Preoperative imaging is key to localizing these adenomas for successful first-time explorations and minimally invasive parathyroidectomies.


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  1. Lee JC, Mazeh H, Serpell J, et al. Adenomas of cervical maldescended parathyroid glands: pearls and pitfalls. ANZ J Surg 2015;85(12):957–961. DOI: 10.1111/ans.12017.
  2. Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2006;191(3):418–423. DOI: 10.1016/j.amjsurg.2005.10.049. Available from: https://www.americanjournalofsurgery.com/article/S0002-9610(05)00929-3/fulltext#.
  3. Roy M, Mazeh H, Chen H, et al. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg 2013;37(1):102–106. DOI: 10.1007/s00268-012-1773-z.
  4. Bliss RD, Gauger PG, Delbridge LW. Surgeon's approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg 2000;24(8):891–897. DOI: 10.1007/s002680010173.
  5. Theurer S, Siebolts U, Lorenz K, et al. Ectopic tissue of the thyroid gland and the parathyroid glands [Internet]. Pathologe 2018;39(5):379–389. DOI: 10.1007/s00292-018-0467-1.
  6. Chan TJ, Libutti SK, McCart JA, et al. Persistent primary hyperparathyroidism caused by adenomas identified in pharyngeal or adjacent structures. World J Surg 2003;27(6):675–679. DOI: 10.1007/s00268-003-6812-3.
  7. Nguyen J, Lau O, Abemayor E, et al. Undescended parathyroid adenoma arising within the hypoglossal nerve. Arch Otolaryn Head Neck Surg 2011;137(7):709–711. DOI: 10.1001/archoto.2011.90.
  8. Kanack MD, Maawy AA, Oh DK, et al. Undescended parathyroid adenoma. BMJ Case Rep 2015;2015(mar03 1):2014–2016. DOI: 10.1136/bcr-2014-208277.
  9. Fraker DL, Doppman JL, Shawker TH, et al. Undescended parathyroid adenoma: an important etiology for failed operations for primary hyperparathyroidism. World J Surg 1990;14(3):342–348. DOI: 10.1007/BF01658522.
  10. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 2016;151(10):959–968. DOI: 10.1001/jamasurg.2016.2310.
  11. Rioja P, Mateu G, Lorente-Poch L, et al. Undescended parathyroid adenomas as cause of persistent hyperparathyroidism. Gland Surg 2015;4(4):295–300. DOI: 10.3978/j.issn.2227-684X.2015.04.14.
  12. Axelrod D, Sisson JC, Cho K, et al. Appearance of ectopic undescended inferior parathyroid adenomas on technetium Tc 99m sestamibi scintigraphy: a lesson from reoperative parathyroidectomy. Arch Surg 2003;138(11):1214–1218. DOI: 10.1001/archsurg.138.11.1214.
  13. Mahajan S, Schoder H. Ectopic undescended parathyroid adenoma-SPECT/CT avoids false-negative interpretation on 99mTc-MIBI dual-phase scintigraphy. Clin Nucl Med 2018;43(3):199–200. DOI: 10.1097/RLU.0000000000001958.
  14. Lee LS, Canter RJ, Fraker DL. Intraoperative jugular venous sampling aids detection of an undescended parathyroid adenoma. World J Surg 2006;30(4):620–623. DOI: 10.1007/s00268-005-0238-z.
  15. Fahy BN, Bold RJ, Beckett L, et al. Modern parathyroid surgery. Arch Surg 2002;137(8):917–923. DOI: 10.1001/archsurg.137.8.917.
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