Excision of mediastinal parathyroid adenoma under the guidance of gamma probe

Abstract

ÖZParatiroid adenomları primer hiperparatiroidizmin en sık nedenidir. Bu yazıda yorgunluk, hiperkalsemi ve hiperparatiroidisi olan 44 yaşında bir erkek hasta sunuldu. Paratiroid sintigrafisi ve torasik bilgisayarlı tomografisinde, ektopik olarak ön mediastende yerleşim gösteren paratiroid adenomu ile uyumlu bir lezyon görüldü. Paratiroid adenomu ameliyat sırası gama prob kılavuzluğunda başarı ile eksize edildi. Paratiroid adenomlarının yerleşiminin ameliyat öncesinde belirlenmesi gereklidir. Bu nedenle; ultrasonografi, paratiroid sintigrafisi ve paratiroid sintigrafisi pozitif olan hastalarda ameliyat sırasında yapılan gama prob kılavuzluğu tanı ve cerrahi tedavinin başarısı için çok önemlidir.Anah tar söz cük ler: Gama prob; ameliyat sırası; paratiroid adenomu. ABSTRACTParathyroid adenomas are the most frequent cause of primary hyperparathyroidism. In this article, we report a 44-year-old male patient with fatigue, hypercalcemia and hyperparathyroidism. Parathyroid scintigraphy and thoracic computed tomography revealed a lesion consistent with parathyroid adenoma ectopically located in the anterior mediastinum. The parathyroid adenoma was excised successfully under the guidance of intraoperative gamma probe. It is essential to determine the localization of parathyroid adenomas preoperatively. Therefore; ultrasonography, parathyroid scintigraphy and guidance of intraoperative gamma probe in patients with positive parathyroid scintigraphy are crucial for diagnosis and success of surgical treatment.Keywords: Gamma probe; intraoperative; parathyroid adenoma.Primary hyperparathyroidism (PHPT) is among the rarely encountered endocrine disorders and frequently manifests with hypercalcemia. Its incidence in adult population is approximately less than 1%. Whilst adenoma in a single parathyroid gland accounts for 85% to 90% of PHPT patients, hyperplasia is responsible for the etiology in 10% to 15% and parathyroid carcinoma is responsible for the etiology in 1% to 2%. Parathyroid adenomas are localized adjacent to thyroid gland by 80% to 90%, whereas they are ectopic by 10%. Ectopic adenomas are found in the anterior mediastinum primarily in the parathymic localization.[1]The main scanning methods used in the diagnosis of primary hyperparathyroidism include ultrasonography and parathyroid scintigraphy performed using technetium-99m (99mTc) methoxyisobutylisonitrile (sestamibi). Computed tomography (CT) and magnetic resonance imaging (MRI) are useful additional scanning methods particularly to localize ectopic parathyroid adenomas.[2] The use of combined radiological methods such as scintigraphy and ultrasonography or scintigraphy and CT enhances the success of clinical approach. For this purpose, the use of hybrid scanning systems such as single-photon emission computed tomography (SPECT)/CT is preferred. SPECT/CT gives more information on the anatomic localization of the lesion particularly in ectopic lesions and in the cases with the history of neck surgery.[3] The basic therapeutic approach for PHPT is surgery. Surgic...