World Journal of Endocrine Surgery

Register      Login

VOLUME 7 , ISSUE 1 ( January-April, 2015 ) > List of Articles


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

Mehmet Uludag, Pinar Yazici, Mehmet Mihmanli, Emre Bozdag, Nurcihan Aygun

Citation Information : Uludag M, Yazici P, Mihmanli M, Bozdag E, Aygun N. Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look?. World J Endoc Surg 2015; 7 (1):1-5.

DOI: 10.5005/jp-journals-10002-1155

Published Online: 01-08-2008

Copyright Statement:  Copyright © 2015; The Author(s).



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 hyperparathyroidism (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 work-up, surgical approach, types of procedures and postoperative complications were noted. Locations of parathyroid adenomas were recorded from operative notes. Statistical analysis was performed using t-test and chi-square. continuous data are expressed as mean ± standard deviation.


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%).


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.

How to cite this article

Yazici P, Mihmanli M, Bozdag E, Aygun N, Uludag M. Location of Parathyroid Adenomas in Primary Hyperparathyroidism: Where to look? World J Endoc Surg 2015;7(1):1-5.

PDF Share
  1. Surgical management of primary hyperparathyroidism. In: Randolph GW, editor. Surgery of thyroid and parathyroid glands. Philadelphia, Pa: WB Saunders; 2003. p. 507-528.
  2. Development and surgical anatomy of the thyroid compartment. In: Terris DJ, Gourin CG, editors. Thyroid and Parathyroid Diseases. New York, NY: Thieme; 2009. p. 11-17.
  3. Surgery for primary hyperparathyroidism 1962-1996: indications and outcome. Med J Aust 1998;168(4):153-156.
  4. Common locations of parathyroid adenomas. Ann Surg Oncol 2011;18(4):1047-1051.
  5. Location of parathyroid adenomas: 7-year experience. J Otolaryngol Head Neck Surg 2010;39(5):551-554.
  6. Prospective evaluation of delayed technetium-99m sestamibi SPECT scintigraphy for preoperative localization of primary hyperparathyroidism. Surg 2002;131(2):149-157.
  7. Advantages of combined technetium-99m-sestamibi scintigraphy and high resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 2000;143(6):755-760.
  8. Prevalence of hypercalcemia in a health screening in Stockholm. Acta Med Scand 1976;200(1-2):131-137.
  9. Validation of the Perrier parathyroid adenoma location nomenclature. World J Surg 2012;36(3):612-616.
  10. Comparison of double-phase 99mTcsestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism. AJR 1997;169(6):1671-1674.
  11. Technetium-99m-sestamibi dual-phase SPECT imaging: concordance with ultrasound. Nucl Med Commun 1999;20(2):487-488.
  12. Role of gamma probes in performing minimally invasive parathyroidectomy in patients with primary hyperparathyroidism: optimization of preoperative and intraoperative procedures. Eur J Endocrinol 2003;149(1):7-15.
  13. Gamma probe guided minimally invasive parathyroidectomy without quick parathyroid hormone measurement in the cases of solitary parathyroid adenomas. Mol Imaging Radionucl Ther 2013;22(1):3-7.
  14. Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. Surg 1999;126(6):1016-1021.
  15. Sestamibi scan-directed unilateral neck exploration for primary hyperparathyroidism due to a solitary adenoma. Eur J Surg Oncol 2000;26(8):785-788.
  16. Predictors of an accurate preoperative sestamibi scan for single-gland parathyroid adenomas. Arch Surg 2007;142(4):381-386.
  17. Operative failure in the era of focused parathyroidectomy: a contemporary series of 845 patients. Arch Surg 2010;145(7):628-633.
  18. Minimally invasive radioguided parathyroidectomy. J Am Coll Surg 2000;191(1):24-31.
  19. Minimally invasive radioguided parathyroidectomy facilitated by intraoperative nuclear mapping. Surg 1997;122(6):998-1004.
  20. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: mayo clinic experience. Arch Surg 2005;140(5):472-478.
  21. Parathyroid pathology in an intrathyroidal position. Am J Surg 1992;164(5):496-500.
  22. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2006;191(3):418-423.
  23. Localization of parathyroid enlargement: experience with technetium 99m methoxyisobutylisonitrile and thallium-201 scintigraphy, ultrasound and computed tomography. Eur J Nucl Med 1994;21(1):17-23.
  24. Concise parathyroidectomy: the impact of preoperative SPECT 99mTc sestamibi scanning and intraoperative quick parathormone assay. Surgery 1997;122(6):1107-1116.
  25. Double parathyroid adenomas. Clinical and biochemical characteristics before and after parathyroidectomy. Ann Surg 1993;218(3):300-307.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.