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Perioperative enhanced recovery after surgery protocols with anterior mediastinal ectopic parathyroid tumor: A case
Xiaodan Zhu1, Yingxia Yu, Kanghui Huang
1Department of Nursing, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, ZheJiang University, YiWu, China.
Rationale:
To summarize the perioperative nursing experience in the successful treatment of anterior mediastinal ectopic parathyroid tumors.
Patient Concerns:
A 50-year-old female, who had previously undergone treatment for a parathyroid adenoma for 7 years, was admitted to the hospital because of recurrent pancreatitis, kidney stones, hypercalcemia (2.98 mmol/L), elevated parathyroid hormone levels (299 pg/mL), and an abnormal parathyroid gland discovered in an external hospital examination 2 months prior.
Diagnoses:
Primary hyperparathyroidism secondary to an anterior mediastinal ectopic parathyroid tumor.
Interventions:
After the patient was admitted to the hospital, an multidisciplinary team discussion was immediately organized and a multidisciplinary collaborative team consisting of endocrinology, radiology, thoracic surgery, general surgery, and nursing departments was formed. The multidisciplinary team evaluated the patient's treatment and ultimately decided to perform pre-diaphragmatic tumor resection under 99mTcO4-MIBI localization and developed a perioperative rapid recovery plan for the patient.
Outcomes:
The patient achieved rapid recovery and was discharged 2 days after surgery. At discharge, serum parathyroid hormone decreased to 16 pg/mL, and serum calcium decreased to 2.68 mmol/L.A follow-up intervention was conducted half a year after discharge, and the patient remained in good recovery condition.
Lessons:
A multidisciplinary enhanced recovery after surgery protocol with a clinical decision support system monitoring enables safe ultra-early discharge, addresses the unique challenges of anterior mediastinal ectopic parathyroid tumor surgery, and provides a replicable framework for complex endocrine perioperative care.
