Abstract
Objectives: To assess the methods of preoperative parathyroid adenoma localization and to compare it with operative findings. Patients and methods: Between June 2017 and June 2019, we had operated 8 cases of parathyroid adenomas. Three patients were males and 5 patients were females. Age ranged from 26 year old to 72 year old with average of 42 year old. Seven cases were sporadic while one case was part of MEN2a. All patients had ultrasonography for preoperative localization, all had CT scan and 4 patients had Sestamibi scan. In all patients, intraoperative measurements of parathyroid hormone was done before and 10 minutes after surgical excision. Results: Ultrasonography was successful in localizing only one case with certainty. CT scan located the adenoma in another 2 patients. In 4 patients who performed Sestamibi scan, the adenomas were located precisely in all of them including one case of ectopic parathyroid adenoma behind the sternum. In one patient, all the modalities failed in localization which was achieved easily intraoperatively. Single adenoma was found in 6 patients and two adenomas in two patients. The adenomas were located in the neck in 7 patients and in the anterior mediastinum in one patient .Surgical removal was done through neck incision in 7 cases while midline sternotomy in one case. All the patients had resolution of symptoms within the follow up period. Conclusion: Sestamibi scan is the best investigation in preoperative localization of parathyroid adenoma. Ultrasonography and CT scan can aid in the diagnosis with less sensitivity. Intraoperative localization is possible even in cases of negative investigations.
Highlights
The parathyroid glands are endocrine glands that are situated in the neck in close relation to the posterior surface of the thyroid gland
Increase in serum PTH can be primary due to parathyroid gland adenoma, hyperplasia or less commonly carcinoma, or it can be secondary to low levels of serum calcium as in cases of renal failure, and the term tertiary hyperparathyroidism describes hyperplasia of the parathyroid glands in long standing secondary hyperparathyroidism.[1,2]
Surgical removal of the adenomas was done without difficulties in all the cases including one patient in whom pre-operative imaging studies could not find the pathology, during exploration an adenoma of 12 mm was found in the usual position and was removed
Summary
The parathyroid glands are endocrine glands that are situated in the neck in close relation to the posterior surface of the thyroid gland. They are four in number divided into 2 superior glands located close to the upper part of the thyroid and 2 inferior glands that are more variable in anatomical position due to the longer pathway in embryological life 1. Parathyroid adenomas are the most common cause of primary hyperparathyroidism, accounting for about 80-85% of the causes, while adenoma of two glands occurs in 4-5%, and in about 10% of the cases 4 glands hyperplasia is the main pathology. The age range for developing adenoma is between 50 and 70 year old with females being affected about 3 times than males. 2,3
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