Introduction. Primary hyperparathyroidism (PHPT) is rare pathology in
children (2-5:100,000). In more than 85% of patients, a single adenoma is
present, and its extirpation is usually the only treatment a patient needs.
In approximately 15-80%of cases, ectopic mediastinal parathyroid tissue can
be found inside the thymus. Case outline. Our patient was a 13-year-old
boy, who presented with multiple bone fractures in the previous period of
time, and fatigue. PTH levels preoperatively were extremely high (1320 pg/ml
- more than 19 times higher than normal). Serum calcium was also elevated
(total 3.55 mmol/l; ionized 1.41 mmol/l). He was examined and diagnosed as
PHPT by a pediatric endocrinologist. Imaging procedures for the preoperative
localization of parathyroid adenomas were done (99mTc sestamibi scintigraphy
and MRI suggested ectopic mediastinal parathyroid adenoma). The patient
underwent video-assisted thoracoscopic surgery procedure. After exploration
of the mediastinum and chest, no ectopic parathyroid tissue was found, so
total thoracoscopic thymectomy was performed. Final pathological section
confirmed parathyroid adenoma inside the thymus. Conclusion. We believe
that if no parathyroid tissue is found during surgical exploration of
mediastinum, in a child with preoperatively detected parathyroid adenoma in
anterior mediastinum, recommendation is to think about possible intrathymal
localization and consider removing the thymus. Greater sample size is
necessary for higher reliability of this statement.
Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus
