Mediastinal Intrathymic Parathyroid Adenoma: A Case Report and Review of the Literature.
| Autor: | Abraham BM Jr; College of Osteopathic Medicine, Marian University, Indianapolis, USA., Sharkey E; Center for Cancer Care, Goshen Health, Goshen, USA., Kwatampora L; Department of Endocrinology, Goshen Health, Goshen, USA., Ranzinger M; Center for Cancer Care, Goshen Health, Goshen, USA., von Holzen U; Center for Cancer Care, Goshen Health, Goshen, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2023 Jul 22; Vol. 15 (7), pp. e42306. Date of Electronic Publication: 2023 Jul 22 (Print Publication: 2023). |
| DOI: | 10.7759/cureus.42306 |
| Abstrakt: | The classic clinical vignette of primary hyperparathyroidism is well described as "bones, stones, abdominal moans, and psychiatric overtones" to reflect the effects of excess parathyroid hormone (PTH) and calcium. Most commonly, primary hyperparathyroidism is due to a functional parathyroid adenoma situated by the thyroid gland. Rarely, the primary focus of autonomously produced PTH is located ectopically within the mediastinum. A 19-year-old Caucasian female with no relevant past medical history presented to the emergency department with tachycardia, nausea, vomiting, and a five-day history of vague, mid-abdominal pain. Initial computed tomography (CT) with contrast of the abdomen and pelvis was negative for acute findings, and she subsequently underwent biochemical screening. The patient was found to have elevated serum calcium and PTH, raising suspicion for the diagnosis of primary hyperparathyroidism. Further evaluation for a parathyroid adenoma was negative by a CT scan of the neck and thyroid ultrasound. A nuclear medicine parathyroid single-photon emission computed tomography (SPECT)/CT with technetium (Tc) 99m sestamibi found an abnormal nodular uptake within the left prevascular mediastinum suggestive of an ectopic parathyroid adenoma. A left-sided, video-assisted thoracoscopic surgery (VATS) with successful excision of the ectopic mediastinal parathyroid adenoma was performed. Surgical pathology revealed that the parathyroid adenoma was completely excised and surrounded by thymus and adipose tissue. The patient tolerated the procedure well and was discharged without further complications. The rarity of mediastinal, intrathymic parathyroid adenomas resulted in delayed diagnosis in this patient, understandably so as errant embryogenesis does not occur commonly. Visualization with SPECT/CT and successful specimen excision by minimally invasive VATS resulted in the accurate diagnosis and ultimate cure of this patient's primary hyperparathyroidism. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2023, Abraham et al.) |
| Databáze: | MEDLINE |
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