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[Ectopic hyperparathyroidism. Detection of mediastinal localization].

Luis A Boccalatte1,2, Natalia L Gómez1, Soledad Olivera López3

  • 1Cirugía de cabeza y cuello, Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Argentina.

Medicina
|February 12, 2020
PubMed
Summary
This summary is machine-generated.

Ectopic mediastinal parathyroid tissue frequently causes recurrent hyperparathyroidism (HPT). Thoracic surgery, including VATS, effectively treats these cases, with intraoperative frozen section and PTH measurement aiding diagnosis and preventing recurrence.

Keywords:
ectopic parathyroid glandshyperparathyroidismmediastinic parathyroidsparathyroid diseases

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Area of Science:

  • Endocrinology
  • Thoracic Surgery
  • Oncology

Background:

  • Ectopic parathyroid tissue is a common cause of recurrent hyperparathyroidism (HPT).
  • Intrathoracic ectopic glands account for 25-35% of ectopic cases, but only 2% necessitate thoracic surgery.
  • Recurrent HPT due to ectopic mediastinal parathyroid glands presents a surgical challenge.

Purpose of the Study:

  • To report a case series of patients with ectopic mediastinal hyperparathyroidism treated via a thoracic approach.
  • To evaluate the efficacy and safety of thoracic surgery for mediastinal parathyroidectomies.
  • To assess the utility of intraoperative techniques like frozen section biopsy and intraoperative parathyroid hormone (iPTH) measurement.

Main Methods:

  • Retrospective analysis of patients with ectopic mediastinal HPT requiring thoracic surgery from January 2006 to June 2019.
  • Surgical procedures included video-assisted thoracoscopy surgery (VATS) and sternotomy.
  • Intraoperative frozen section biopsy and iPTH measurements were utilized in all/most cases.

Main Results:

  • Nine patients (6 primary HPT, 3 secondary HPT) underwent thoracic surgery.
  • Six VATS and 3 sternotomies were performed with no serious postoperative complications.
  • Frozen section and iPTH measurements (mean 65% drop) confirmed diagnosis and guided treatment, with final pathology revealing 5 adenomas and 4 hyperplasias.

Conclusions:

  • Thoracic surgical approach, including VATS, is safe and effective for ectopic mediastinal HPT.
  • Intraoperative frozen section and iPTH monitoring are crucial for accurate diagnosis and preventing recurrence.
  • While sestamibi remains standard, 18F-choline PET/CT shows promise for future diagnosis.