Robot-assisted complete thymectomy for mediastinal ectopic parathyroid adenomas in primary hyperparathyroidism

2016 ◽  
Vol 11 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Alison F. Ward ◽  
Timothy Lee ◽  
Jennifer B. Ogilvie ◽  
Kepal N. Patel ◽  
Karen Hiotis ◽  
...  
1996 ◽  
Vol 37 (3P2) ◽  
pp. 720-726 ◽  
Author(s):  
C. Tziakouri ◽  
E. Eracleous ◽  
S. Skannavis ◽  
A. Pierides ◽  
P. Symeonides ◽  
...  

Purpose: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgical outcome in patients with primary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in 87% of these patients. Conclusion: US, CT and MR imaging followed by surgery performed by an experienced surgeon provided good clinical results in 39 patients with primary hyperparathyroidism. Preoperative localization was especially useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the root of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery.


2021 ◽  
Vol 233 (5) ◽  
pp. S67-S68
Author(s):  
Regina Matar ◽  
Katherine Jackson ◽  
Michael Wright ◽  
Deanna Cotsalas ◽  
Susan Hobbs ◽  
...  

2004 ◽  
Vol 122 (1) ◽  
pp. 32-34 ◽  
Author(s):  
Rogério Aparecido Dedivitis ◽  
André Vicente Guimarães ◽  
Gustavo Bastos de Goes Pontes

CONTEXT: Primary hyperparathyroidism is the most common cause of hypercalcemia in unselected patients. The ectopic gland locations should be known for appropriate surgical exploration and for avoiding subsequent re-exploration that would represent higher morbidity. Multiple ectopic glands are rare and present a particular challenge in parathyroid surgery. CASE REPORT: A 65-year-old female presented with nephrolithiasis. Her serum total calcium was found to be elevated. The diagnosis of primary hyperparathyroidism was confirmed by the elevated serum intact parathyroid hormone levels. Ultrasound was only successful in localizing one adenoma in the lower right gland. Technetium sestamibi scanning correctly localized the same adenoma and showed another contralateral image, lateral to the thyroid cartilage. Fiber optic laryngoscopy showed an extrinsic mass pushing against the lateral and posterior walls of the left pyriform sinus. Resonance imaging revealed a soft tissue mass. RESULTS: The patient underwent bilateral neck exploration. Histopathological examination confirmed the diagnosis of parathyroid double adenomas. The late-stage postoperative checkups were normal. DISCUSSION: Routine bilateral neck surgery should be performed as a rule. We use ultrasound and technetium sestamibi scanning as a routine for preoperative localization studies. It is helpful to have an experienced surgeon for the localization.


2016 ◽  
Vol 67 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Wade Koberstein ◽  
Christopher Fung ◽  
Kristy Romaniuk ◽  
Jonathan T. Abele

Purpose The objectives of this study were: 1) to determine the accuracy of dual-phase 99mTc -methoxyisobutylisonitrile (MIBI) with single-photon emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of parathyroid adenomas in the setting of primary hyperparathyroidism; 2) to determine the accuracy of localization for ectopic glands; and 3) to assess the relationship between accuracy and serum parathyroid hormone (PTH) levels. Methods Eighty-eight patients who underwent 99mTc-MIBI SPECT/CT imaging for primary hyperparathyroidism at our institution over a 27-month period were retrospectively assessed. The preoperative SPECT/CT results were compared to intraoperative findings (within 1 year of imaging). The relationship between serum PTH level (within 3 months) and SPECT/CT accuracy was then evaluated. Results Accuracy indices for the retrothyroid subgroup were sensitivity 86.7%, specificity 96.4%, positive predictive value 98.1%, negative predictive value 77.1%, and accuracy 89.8%. Accuracy indices for ectopic parathyroid adenomas were sensitivity 81.5%, specificity 100%, positive predictive value 100%, negative predictive value 92.4%, and accuracy 94.3%. For the overall group, SPECT/CT demonstrated a sensitivity of 85.1% and a PPV of 98.7%. SPECT/CT correctly identified the abnormal parathyroid gland in 60% of patients with a normal serum PTH (<6.9 pmol/L), 73% between 6.9-9.9 pmol/L, 86% between 10.0-14.9 pmol/L, 100% between 15.0-19.9 pmol/L, 88% between 20.0-24.5 pmol/L, and 100% of patients with a PTH greater than 25.0 pmol/L. Conclusions Dual-phase 99mTc- MIBI with SPECT/CT is an accurate and reliable means to correctly localize both retrothyroid and ectopic parathyroid adenomas for the purpose of surgical planning. The accuracy of SPECT/CT increases with increasing serum PTH levels.


Author(s):  
Camilo Levi Acuna Pinzon ◽  
Eduardo Morales Valencia ◽  
Jefferson Nieves Condoy ◽  
Luis Abraham Zuniga Vasquez ◽  
Arturo Jorge Sotelo

Approximately 80% of patients with primary hyperparathyroidism have a parathyroid adenoma, with surgery being the only definitive treatment. Sometimes in surgery there is difficulty in identifying the pathological parathyroid gland at which time the possibility of ectopic parathyroid should be considered. We present two cases of patients which after hemithyroidectomy histopathological report, reported intrathyroid parathyroid adenoma. Intrathyroid parathyroid adenomas are an infrequent presentation of parathyroid adenomas that require high clinical suspicion if they are not detected by imaging studies in the preoperative period.


2015 ◽  
Vol 97 (4) ◽  
pp. 259-261 ◽  
Author(s):  
Jesse Hu ◽  
KY Ngiam ◽  
R Parameswaran

Primary hyperparathyroidism is a relatively common problem encountered by any endocrine surgical unit. Ectopic parathyroid adenomas have been known to be a common cause of persistent hyperparathyroidism after surgery. A common site of the missed ectopic gland will be that in the mediastinum. However, with the increasing improvement in available imaging, it is likely that this can be diagnosed preoperatively. The surgical approach to the mediastinal parathyroid has also changed vastly over the last decade from maximally invasive to minimally invasive with minimal complications. We provide a review on the entity of mediastinal parathyroid adenomas and their surgical implications.


2021 ◽  
Author(s):  
Steven Raeymaeckers ◽  
Yannick De Brucker ◽  
Tim Vanderhasselt ◽  
Nico Buls ◽  
Johan De Mey

Abstract Background. 4DCT is a commonly performed examination in the management of primary hyperparathyroidism, combining three-dimensional imaging with enhancement over time as the fourth dimension. We propose a novel technique consisting of 16 different contrast phases, instead of three or four different phases. The main aim of this study was to see if this protocol allows for the detection of parathyroid adenomas within dose limits. Our secondary aim was examining the enhancement of parathyroid lesions over time.Methods. For this prospective study, we included 15 patients with primary hyperparathyroidism prior to surgery. We obtain a 4DCT with 16 different phases: an unenhanced phase followed by 11 consecutive arterial phases and 4 venous phases. Centered on the thyroid, continuous axial scanning is performed over a fixed 8cm or 16cm coverage volume after start of contrast administration.Results. In all patients an enlarged parathyroid can be demonstrated, mean lesion size is 13.6mm. Mean peak arterial peak enhancement for parathyroid lesions is 384 HU compared to 333 HU for the normal thyroid. No statistical difference could be found. Time to peak (TTP) is significantly earlier for parathyroid adenomas compared to normal thyroid tissue: 30.8s versus 32.3s (p value 0.008). Mean Slope of Increase (MSI) of the enhancement curve is significantly steeper compared to normal thyroid tissue: 29.8% versus 22.2% (p value 0.012). Mean dose length product was 890.7 mGy.cm with a calculated effective dose of 6.7 mSv.Conclusion. We propose a feasible 4DCT scanning-protocol for the detection of parathyroid adenomas. We manage to obtain a multitude of phases, allowing for a dynamic evaluation within an acceptable exposure range when compared to classic helical 4DCT. Our 4DCT protocol may allow for a better visualization of the pattern of enhancement of parathyroid lesions, as enhancement over time curves can be drawn. This way wash-in and wash-out of contrast in suspected lesions can be readily demonstrated. Motion artifacts are less problematic as multiple phases are available.


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