Primary Hyperparathyroidism due to Parathyroid Adenoma Originated from Supernumerary Gland

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.

Transoral Excision of a High Retropharyngeal Parathyroid

ABSTRACT In patients with renal failure, hypocalcemia leads to multiglandular parathyroid growth and parathyroid hypersecretion. Parathyroidectomy has been shown to decrease cardiovascular events and mortality in these patients. One of the challenges of surgery for secondary hyperparathyroidism is the high reported incidence of supernumerary and ectopic glands. This in conjuction with reported low sensitivity of preoperative imaging studies in multigland disease and unclear criteria for intraoperative PTH in 2HPT may lead to incomplete parathyroidectomy and need for reoperation. We report a case of recurrent 2HPT from an ectopic supernumerary gland in the high retropharyngeal region found by CT imaging. Due to the patient's obesity, short neck and history of prior neck surgery, we elected to excise the gland transorally using intraoperative EUS.