Persistent primary hyperparathyroidism caused by adenomas identified in pharyngeal or adjacent structures

Area of Science:

• Endocrinology
• Surgical Anatomy
• Embryology

Background:

• Parathyroid gland development involves complex embryological migration.
• Aberrant migration can lead to ectopic parathyroid tissue, often causing persistent primary hyperparathyroidism (HPT).
• Ectopic adenomas present diagnostic and surgical challenges, frequently leading to treatment failure after initial surgery.

Purpose of the Study:

• To report a series of patients with persistent primary HPT due to ectopic parathyroid adenomas in unusual pharyngeal locations.
• To emphasize the role of preoperative imaging in localizing these rare adenomas.
• To demonstrate the efficacy of direct surgical approaches for treating HPT caused by ectopic parathyroid tissue.

Main Methods:

• Retrospective case series of eight patients with persistent primary HPT.
• Detailed review of preoperative noninvasive and invasive imaging studies.
• Analysis of surgical approaches and outcomes for ectopic parathyroid adenomas.

Main Results:

• Eight patients had persistent primary HPT caused by ectopic parathyroid adenomas.
• Four adenomas were located within the vagus nerve epineurium; four were in the paranasopharyngeal space or oropharynx.
• Preoperative imaging was crucial for localization, enabling direct surgical approaches and cure in all patients with low complication rates.

Conclusions:

• Ectopic parathyroid adenomas in rare pharyngeal locations are a significant cause of persistent primary HPT.
• Advanced imaging techniques are essential for precise localization of these challenging lesions.
• Direct surgical intervention based on accurate localization leads to successful treatment and cure of persistent primary HPT.