Abstract
Introduction The variability of the location of the parathyroid glands is directly related to the events that occur during embryonic development. The impact that an individual submits more than four parathyroid glands is close to 13%. However the presentation of a parathyroid adenoma in a supernumerary gland is an uncommon event. Case report A 30-year-old man diagnosed with primary hyperparathyroidism with matching findings on ultrasonography and scintigraphy for parathyroid adenoma localization lower left regarding the thyroid gland. A cervicotomy explorer showed four orthotopic parathyroid glands. The biopsy of the inferior left gland was normal. No signs of adenoma were seen in the biopsy. Following mobilization of the ipsilateral thyroid lobe, fifth parathyroid gland was found increased significantly in size than proceeded to remove, confirming the diagnosis of adenoma. After the excision, the levels of serum calcium and parathyroid hormone were normalized. Conclusions The presentation of a parathyroid adenoma in a supernumerary gland is a challenge for the surgeon. The high sensitivity having different imaging techniques has been a key to locate preoperatively the pathological parathyroid gland. Analytical or clinical persistence of primary hyperparathyroidism after parathyroid surgery can occur if the location of the adenoma is a supernumerary or ectopic gland location.
Highlights
Primary hyperparathyroidism is the most frequent cause of increased serum calcium levels. e main cells of the parathyroid glands are responsible for secreting the parathormone which is involved in the reabsorption of calcium at the level of the distal tubule of the nephron, stimulating osteoclasts to promote bone resorption and catalyze the conversion of vitamin D3 in its active form [1]
We present the case of a 30-year-old male with a history of primary hyperparathyroidism originated in a supernumerary parathyroid gland of ectopic location
We present the case of a 30-year-old male patient who referred to our clinic with the diagnosis of primary hyperparathyroidism. e patient had a history of stage IV-B non-Hodgkin lymphoma diagnosed in 2005 and treated with radiochemotherapy, currently in remission
Summary
Primary hyperparathyroidism (pHPT) is the most frequent cause of increased serum calcium levels. e main cells of the parathyroid glands are responsible for secreting the parathormone (pHPT) which is involved in the reabsorption of calcium at the level of the distal tubule of the nephron, stimulating osteoclasts to promote bone resorption and catalyze the conversion of vitamin D3 in its active form [1].e incidence of pHPT is 4 inhabitants per 1,000. We present the case of a 30-year-old male with a history of primary hyperparathyroidism originated in a supernumerary parathyroid gland of ectopic location. Cervical exploration of the four glands has been considered as the gold standard in those patients who are going to undergo pHPT and whose location of the pathological gland does not show coincidences in the preoperative imaging tests.
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