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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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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