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Related Experiment Videos

[65-year old female patient with persistent hypercalcemia].

M Wiedmann1, W Kassahun, F Deckert

  • 1Medizinische Klinik und Poliklinik II, Universität Leipzig, Philipp-Rosenthal-Strasse 27, Leipzig, Germany. wiedm@medizin.uni-leipzig.de

Der Internist
|October 30, 2007
PubMed
Summary

A patient with primary hyperparathyroidism had an ectopic parathyroid adenoma located in the jaw. This rare finding required advanced imaging and surgical reexploration for successful treatment.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Nuclear Medicine

Background:

  • Primary hyperparathyroidism is characterized by excessive parathyroid hormone (PTH) production, leading to hypercalcemia.
  • Surgical exploration is the standard treatment, but locating the source of excess PTH can be challenging, especially with ectopic adenomas.
  • Multinodular goiter can complicate neck surgery, potentially obscuring parathyroid glands.

Observation:

  • A 65-year-old patient presented with hypercalcemia and elevated PTH levels, initially suspected to have primary hyperparathyroidism.
  • Initial surgical exploration during a thyroidectomy for multinodular goiter failed to identify a parathyroid adenoma.
  • Advanced imaging, including technetium-99m sestamibi scintigraphy with SPECT, ultrasound, CT scan, and selective venous sampling, was employed for localization.

Findings:

  • An ectopic parathyroid adenoma was successfully localized to the submandibular region of the left jaw.
  • Surgical reexploration confirmed and removed the ectopic adenoma.
  • Postoperatively, PTH levels normalized, and the patient experienced symptomatic hypocalcemia requiring temporary calcium supplementation.

Implications:

  • This case highlights the importance of considering ectopic parathyroid adenomas in cases of persistent hyperparathyroidism after negative neck exploration.
  • Advanced imaging techniques are crucial for localizing rare ectopic adenomas.
  • Successful management of ectopic parathyroid adenomas can be achieved with thorough diagnostic workup and tailored surgical reintervention.