[Ectopic mediastinal parathyroid adenoma].

Area of Science:

• Endocrinology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Primary hyperparathyroidism is often caused by parathyroid adenomas.
• Ectopic mediastinal parathyroid adenomas are rare but can cause significant hypercalcemia.

Observation:

• Three patients presented with elevated serum calcium and parathyroid hormone levels, indicative of primary hyperparathyroidism.
• Diagnostic imaging, including technetium-99m-methoxy-isobutyl-isonitrile (MIBI) scintigraphy, CT, and MRI, identified mediastinal parathyroid adenomas.
• MIBI scintigraphy proved particularly effective for detecting small ectopic adenomas.

Findings:

• Surgical resection of mediastinal parathyroid adenomas, located via imaging, led to immediate normalization of calcium and parathyroid hormone levels.
• Large posterior mediastinal tumors were presumed to originate from upper parathyroid glands, while smaller anterior mediastinal tumors likely arose from lower glands.
• Resection was achieved through thoracotomy, cervical incision, or sternotomy, depending on tumor location.

Implications:

• Accurate preoperative localization of ectopic parathyroid adenomas is crucial for minimally invasive surgical approaches.
• Advanced imaging techniques enhance the diagnosis and management of rare parathyroid conditions.
• Successful surgical intervention resolves hypercalcemia and associated symptoms, improving patient outcomes.