Indian Journal of Endocrine Surgery and Research

Register      Login

VOLUME 19 , ISSUE 1 ( January-June, 2024 ) > List of Articles

CASE REPORT

The Mediastinal Parathyroid-peeping through the Window

Swarna Azaria, Shawn Sam Thomas, Kripa Elizabeth Cherian, Vinay Murahari Rao, Elanthenral Sigamani, Mazhuvanchary Jacob Paul

Keywords : Case report, Hyperparathyroidism, Parathyroid adenoma, Primary hyperparathyroidism

Citation Information : Azaria S, Thomas SS, Cherian KE, Rao VM, Sigamani E, Paul MJ. The Mediastinal Parathyroid-peeping through the Window. 2024; 19 (1):26-29.

DOI: 10.5005/jp-journals-10088-11237

License: CC BY-NC 4.0

Published Online: 17-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Mediastinal parathyroid adenomas (MPAs) result from aberrant migration of the parathyroid during development, constituting 20% of ectopically located adenomas. Aortopulmonary window (APW) parathyroid adenomas are rare, accounting for only 1% of ectopic mediastinal adenomas and 0.24% of all parathyroid adenomas. We present here a case of an MPA in the APW which was managed surgically and a brief review of the literature. Case description: A man in his 30s presented with low-backaches and recurrent renal calculi for 7 years, and also a history of fatigue, increased irritability, and insomnia. He was detected to have hypercalcemia, with inappropriately elevated parathyroid hormone (PTH), with background chronic kidney disease probably due to nephrocalcinosis. The ultrasound thyroid showed small subcentimetric doubtful parathyroid lesions in their ectopic locations. Tc99SestaMIBI scan detected an MPA, which on CT neck and thorax revealed an ~ 2.1 × 2 cm lesion in the APW. He underwent a left posterolateral thoracotomy with excision of APW parathyroid + cervical exploration and excision of left superior parathyroid and left inferior parathyroid biopsy. His PTH and calcium levels normalized postoperatively. Discussion: Aortopulmonary window parathyroid adenomas are very rare, usually located in the middle mediastinum, and are postulated to be supernumerary glands in 58–60%. The blood supply is derived from the mediastinum, from the bronchial arteries or internal mammary artery. The cervical approach is not feasible for adenomas in this location, and video-assisted thoracoscopic surgery (VATS)/thoracotomy is required. Conclusion: Structural imaging is paramount when MPAs are suspected, for appropriate surgical planning and management.


PDF Share
  1. Khalaf SH, Sarwani AA, George SM, et al. Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in an uncommon location: A case report. J Taibah Univ Med Sci 2021;16(5):782–787. DOI: 10.1016/j.jtumed.2021.02.010.
  2. Phitayakorn R, McHenry CR. Incidence and location of ectopic abnormal parathyroid glands. Am J Surg 2006;191(3):418–423. DOI: 10.1016/j.amjsurg.2005.10.049.
  3. Roy M, Mazeh H, Chen H, et al. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg 2013;37(1):102–106. DOI: 10.1007/s00268-012-1773-z.
  4. Arnault V, Beaulieu A, Lifante J, et al. Multicenter study of 19 aortopulmonary window parathyroid tumors: The challenge of embryologic origin. World J Surg 2010;34(9):2211–2216. DOI: 10.1007/s00268-010-0622-1.
  5. Hu J, Ngiam K, Parameswaran R. Mediastinal parathyroid adenomas and their surgical implications. Ann R Coll Surg Engl 2015;97(4): 259–261. DOI: 10.1308/003588415X14181254789088.
  6. Cohn KH, Silen W. Lessons of parathyroid reoperations. Am J Surg 1982;144(5):511–517. DOI: 10.1016/0002-9610(82)90569-4.
  7. Caldarella C, Treglia G, Isgrò MA, et al. Diagnostic performance of positron emission tomography using 11C-methionine in patients with suspected parathyroid adenoma: A meta-analysis. Endocrine 2013;43(1):78–83. DOI: 10.1007/s12020-012-9746-4.
  8. Bondje S, Kaplan F, Palazzo F, et al. Resection of an elusive parathyroid adenoma in the aortopulmonary window. BMJ Case Rep CP 2023;16(2):e250380. DOI: 10.1136/bcr-2022-250380.
  9. Medrano C, Hazelrigg SR, Landreneau RJ, et al. Thoracoscopic resection of ectopic parathyroid glands. Ann Thorac Surg 2000;69(1):221–223. DOI: 10.1016/s0003-4975(99)01127-3.
  10. Hemead HM, Abdellatif AA, Abdel Rahman MA. Ectopic pure mediastinal parathyroid adenoma: A case report. Int J Surg Case Rep 2022;90:106598. DOI: 10.1016/j.ijscr.2021.106598.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.