Management of mediastinal parathyroid adenoma via minimally invasive thoracoscopic surgery: Case report
| Autor: | Hina Inam, Farida Karim Chagan, Usama Khalid Choudry, Saulat H. Fatimi |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
endocrine system diseases Adenoma VATS Disease 030230 surgery Scintigraphy Article 03 medical and health sciences 0302 clinical medicine Case report medicine Idiopathic hypercalcemia Parathyroid adenoma Ectopic parathyroid adenoma Hyperparathyroidism medicine.diagnostic_test business.industry fungi food and beverages nutritional and metabolic diseases medicine.disease Surgery Decreased bone mineral density 030220 oncology & carcinogenesis Abnormality business hormones hormone substitutes and hormone antagonists Primary hyperparathyroidism |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2017.08.056 |
| Popis: | Highlights • Ectopic parathyroid adenomas are rare. • PA’s can cause idiopathic hypercalcemia. • VATS in the recommended treatment of choice. Introduction The most common cause of chronic hypercalcemia is primary hyperparathyroidism (PHPT). However, owing to the diverse presentation of hypercalcemia, the diagnosis often goes unnoticed culminating as a continuum of recurrence of symptoms. Nephrolithiasis, decreased bone mineral density and peptic ulcer disease are the main clinical sequelae. Among the causes of PHPT 80% are caused by parathyroid adenomas (PA). However, only rarely, these adenomas are found ectopically. Presentation of case We present the case of a 66-year-old female with a history of recurrent renal stones and peptic ulcer disease. She was found to have elevated serum calcium and PTH levels. However, subsequent high resolution CT scan of chest and neck failed to demonstrate any abnormality. Therefore, an anterior planar Technetium-99m-sestamibi (MIBI) scintigraphy scan using a single-tracer was done and it identified ectopic anterior mediastinal parathyroid adenoma. The patient was successfully managed with video-assisted thoracoscopic surgery and excision of the mass with follow up calcium level monitoring. Disscussion An elevated calcium level should prompt a thorough workup, as sometimes it's the only clue to the unrelated and diversified systemic manifestations of hypercalcemia. Hyperparathyroidism due to ectopic adenoma is quite rare and possess a diagnostic and management challenge. Conclusion Symptomatic hypercalcemia and high level of PTH without local PA should alert physicians to search for ectopic locations through imaging. VATS is a safe and effective minimally invasive procedure for the resection of ectopic mediastinal PA and it should be considered as the first line approach for resection of these ectopic tumors. |
| Databáze: | OpenAIRE |
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