Mediastinal hyperfunctioning parathyroids: incidence, evolving treatment, and outcome.

Nilubol N, Beyer T, Prinz RA, Solorzano CC
Am J Surg. 2007 194 (1): 53-6

PMID: 17560909 · DOI:10.1016/j.amjsurg.2006.11.019

BACKGROUND - The evaluation and treatment of hyperfunctioning mediastinal parathyroid gland(s) (MPG) is evolving. This study reports our overall experience with MPG in a tertiary referral center.

METHODS - A prospective database of 922 patients undergoing parathyroidectomy by 2 surgeons from 1982 to 2005 was reviewed.

RESULTS - Thirty-two of 922 (3.5%) patients had MPG. Nine (28%) patients had a prior failed parathyroidectomy. Sestamibi and computed tomography scans were correctly positive in 24/28 (86%) and 6/7 (86%) patients, respectively. MPGs were removed via cervical approach in 22 (69%). Eleven of 22 patients had a focused cervical approach. Nine MPGs required a limited sternotomy (n = 3) or a successful radioguided video-assisted thoracoscopic approach (VATS, n = 4) for removal. Two VATS were converted to a full sternotomy. One patient refused surgery. All patients who required sternotomy/VATS had MPGs caudal to the innominate vein. Twenty-nine of 31 (94%) patients were cured. Two are stable on calcimimetics. One patient has permanent hypoparathyroidism.

CONCLUSIONS - Most MPGs can be removed through a cervical approach. Preoperative Sestamibi and computed tomography scans can help the surgeon plan the best initial surgical approach. Those below the innominate vein require a thoracic procedure, preferably a radioguided probe-assisted thoracoscopic resection with intraoperative parathyroid hormone (ioPTH). An alternative to surgical removal is medical treatment.

MeSH Terms (11)

Adult Aged Aged, 80 and over Female Humans Hyperparathyroidism Incidence Male Mediastinum Middle Aged Parathyroidectomy

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