Scientific paper
Incidence and location of ectopic abnormal parathyroid glands

Presented at the 48th Annual Meeting of the Midwest Surgical Association, Ontario, Canada, August 14–17, 2005
https://doi.org/10.1016/j.amjsurg.2005.10.049Get rights and content

Abstract

Background

Ectopic parathyroid glands are a cause for failed parathyroid exploration.

Methods

Patients with hyperparathyroidism and ectopic parathyroid glands were identified from a parathyroid database. Laboratory data, gland weights, and surgical outcomes were obtained. The locations of the ectopic glands were correlated with results of technetium-99m–sestamibi imaging.

Results

Of 231 patients operated on for hyperparathyroidism, 37 (16%) had ectopic parathyroid glands. Ectopic inferior glands (N = 23 [62%]) were intrathymic, n = 7 (30%); anterosuperior mediastinal, n = 5 (22%); intrathyroidal, n = 5 (22%); within the thyrothymic ligament, n = 4 (17%); and submandibular, n = 2 (9%). Ectopic superior glands (N = 14 [38%]) were in the tracheoesophageal groove, n = 6 (43%); retroesophageal, n = 3 (22%); posterosuperior mediastinal, n = 2 (14%); intrathyroidal, n = 1 (7%); in the carotid sheath, n = 1 (7%); and paraesophageal, n = 1 (7%). Sestamibi scans were true-positive in 81%, identifying 13 of 16 retrosternal glands, and false-negative in 19%.

Conclusions

A 16% incidence of ectopic parathyroid glands and a 100% positive predictive value of sestamibi scintigraphy underscore the importance of sestamibi imaging in patients with primary hyperparathyroidism.

Section snippets

Methods

Epidemiologic data, laboratory indices, and location and weight of excised ectopic parathyroid glands were collected from a parathyroid database and a retrospective chart review of consecutive patients operated on for hyperparathyroidism from 1990 to 2005. The anatomic location of abnormal ectopic parathyroid glands was determined from operative reports and was compared to the results of preoperative 99mTc-sestamibi scintigraphy. The institutional review board approved the study.

An ectopic

Results

Of the 231 patients operated on for hyperparathyroidism, 37 (16%) had an abnormal ectopic parathyroid gland, 34 (17%) of 195 patients with primary hyperparathyroidism, 1 (6%) of 16 patients with secondary hyperparathyroidism, and 2 (10%) of 20 patients with tertiary hyperparathyroidism. Among the 37 patients, a bilateral neck exploration was performed in all patients except for 5 (14%) who were operated on for persistent or recurrent hyperparathyroidism. Thirty-four patients had a single (30)

Comments

It is imperative for the surgeon who is treating patients with hyperparathyroidism to have a thorough understanding of the embryological development and normal anatomy of the parathyroid glands and the potential sites for ectopic parathyroid tissue. Ectopic parathyroid adenomas have previously been reported to account for 4% to 10% of the pathology in patients with hyperparathyroidism [4], [5]. Our findings suggest that the incidence of ectopic parathyroid glands is higher than previously

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