Intravagal ectopic parathyroid adenoma: Challenging perioperative localisation

Introduction: Persistent hyperparathyroidism is usually due to a missed parathyroid adenoma, which can be located at variable though well-described locations within the neck and mediastinum due to the gland's embryological descent. We describe a rare case of an intravagal parathyroid adenoma th...

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Main Authors: Luke M. O'Neil, Nicholas Leith, Sandeep K. Gupta, Shaun McGrath, Robert L. Eisenberg
Format: Article
Language:English
Published: Elsevier 2019-03-01
Series:Otolaryngology Case Reports
Online Access:http://www.sciencedirect.com/science/article/pii/S2468548818301589
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spelling doaj-94aacc459cc14282a7449a97cb5b03872020-11-25T03:26:22ZengElsevierOtolaryngology Case Reports2468-54882019-03-01103638Intravagal ectopic parathyroid adenoma: Challenging perioperative localisationLuke M. O'Neil0Nicholas Leith1Sandeep K. Gupta2Shaun McGrath3Robert L. Eisenberg4Department of Otolaryngology, Head and Neck Surgery, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Australia; Corresponding author. Department of Otolaryngology, Head and Neck Surgery, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW, 2305, Australia.Department of Otolaryngology, Head and Neck Surgery, John Hunter Hospital, Newcastle, NSW, AustraliaSchool of Medicine and Public Health, University of Newcastle, Australia; Department of Nuclear Medicine, John Hunter Hospital, Newcastle, NSW, AustraliaSchool of Medicine and Public Health, University of Newcastle, Australia; Department of Endocrinology, John Hunter Hospital, Newcastle, NSW, AustraliaDepartment of Otolaryngology, Head and Neck Surgery, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, AustraliaIntroduction: Persistent hyperparathyroidism is usually due to a missed parathyroid adenoma, which can be located at variable though well-described locations within the neck and mediastinum due to the gland's embryological descent. We describe a rare case of an intravagal parathyroid adenoma that illustrates the benefit of multiple localisation modalities. Case summary: A 43-year-old man was referred with primary hyperparathyroidism. Sestamibi demonstrated uptake of equivocal suspicion posterior to the right hemithyroid; ultrasound of this area was negative. Initial exploration failed to find an adenoma or left inferior parathyroid. Repeat sestamibi, 4D-CT and selective venous sampling localised the adenoma to the left upper neck. An intravagal parathyroid adenoma was identified intraoperatively with gamma probe and completely excised. The patient was biochemically cured and had normal vocal cord function at follow up. Discussion: Awareness of the possibility of intravagal parathyroid adenoma is important, especially in cases where preoperative localisation is uncertain. Intraoperative localisation with gamma probe can be a useful adjunct to achieve cure in such cases. Keywords: Parathyroid adenoma, Hyperparathyroidism, Ectopic, Gamma probehttp://www.sciencedirect.com/science/article/pii/S2468548818301589
collection DOAJ
language English
format Article
sources DOAJ
author Luke M. O'Neil
Nicholas Leith
Sandeep K. Gupta
Shaun McGrath
Robert L. Eisenberg
spellingShingle Luke M. O'Neil
Nicholas Leith
Sandeep K. Gupta
Shaun McGrath
Robert L. Eisenberg
Intravagal ectopic parathyroid adenoma: Challenging perioperative localisation
Otolaryngology Case Reports
author_facet Luke M. O'Neil
Nicholas Leith
Sandeep K. Gupta
Shaun McGrath
Robert L. Eisenberg
author_sort Luke M. O'Neil
title Intravagal ectopic parathyroid adenoma: Challenging perioperative localisation
title_short Intravagal ectopic parathyroid adenoma: Challenging perioperative localisation
title_full Intravagal ectopic parathyroid adenoma: Challenging perioperative localisation
title_fullStr Intravagal ectopic parathyroid adenoma: Challenging perioperative localisation
title_full_unstemmed Intravagal ectopic parathyroid adenoma: Challenging perioperative localisation
title_sort intravagal ectopic parathyroid adenoma: challenging perioperative localisation
publisher Elsevier
series Otolaryngology Case Reports
issn 2468-5488
publishDate 2019-03-01
description Introduction: Persistent hyperparathyroidism is usually due to a missed parathyroid adenoma, which can be located at variable though well-described locations within the neck and mediastinum due to the gland's embryological descent. We describe a rare case of an intravagal parathyroid adenoma that illustrates the benefit of multiple localisation modalities. Case summary: A 43-year-old man was referred with primary hyperparathyroidism. Sestamibi demonstrated uptake of equivocal suspicion posterior to the right hemithyroid; ultrasound of this area was negative. Initial exploration failed to find an adenoma or left inferior parathyroid. Repeat sestamibi, 4D-CT and selective venous sampling localised the adenoma to the left upper neck. An intravagal parathyroid adenoma was identified intraoperatively with gamma probe and completely excised. The patient was biochemically cured and had normal vocal cord function at follow up. Discussion: Awareness of the possibility of intravagal parathyroid adenoma is important, especially in cases where preoperative localisation is uncertain. Intraoperative localisation with gamma probe can be a useful adjunct to achieve cure in such cases. Keywords: Parathyroid adenoma, Hyperparathyroidism, Ectopic, Gamma probe
url http://www.sciencedirect.com/science/article/pii/S2468548818301589
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