Advertisement
Surgery
Advanced searchSave search
Research Article| Volume 116, ISSUE 6, P982-990, December 1994

Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism

  • Kevin G. Billingsley
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
  • Douglas L. Fraker
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
  • John L. Doppman
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
  • Jeffrey A. Norton
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
  • Thomas H. Shawker
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
  • Monica C. Skarulis
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
  • Stephen J. Marx
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
  • Allen M. Spiegel
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
  • H.Richard Alexander
    Correspondence
    Reprint requests: H. Richard Alexander, MD, Surgical Metabolism Section, National Cancer Institute, Building 10, Rm. 2B17, Bethesda, MD 2O892.
    Affiliations
    Surgical Metabolism Section, Surgery Branch, National Cancer Institute, National Institutes of Health, the Metabolic Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., USA

    Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Md., USA

    Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
    Search for articles by this author
DOI:https://doi.org/10.5555/uri:pii:0039606094902933
Localization and operative management of undescended parathyroid adenomas in patients with persistent primary hyperparathyroidism
Previous ArticlePositron emission tomography with 11 C-methionine in hyperparathyroidism
Next ArticlePersistent and recurrent sporadic primary hyperparathyroidism: Histopathology, complications, and results of reoperation
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Background. Between 5% and 10% of patients who undergo cervical exploration for primary hyperparathyroidism will have persistent or recurrent hyperparathyroidism. Many of these patients have parathyroid tumors in unusual locations. One such site of ectopic parathyroid tissue is an undescended parathyroid adenoma at or superior to the carotid bifurcation. We describe our experience with the preoperative localization and surgical management of undescended parathyroid adenomas.
      Methods. From 1982 to 1993 a consecutive series of 2,55 patients have undergone localization studies and surgical exploration for persistent or recurrent hyperparathyroidism at the Clinical Center of the National Institutes of Health. Operative strategy was determined by review of the patient's surgical history, disease reports, and data from localizing studies. Patients with an underscended parathyroid adenoma identified before the operation were examined with a direct approach high in the neck. Patients who did not have definitive preoperative localization were explored with the previous transverse cervical incision.
      Results. Seventeen undescended parathyroid adenomas were identified in 255 patients. Thirteen (76%) of 17 patients had an undescended parathyroid adenoma precisely localized before the operation and were examined via a limited, oblique incision high in the neck anterior to the sternocleidomastoid muscle. In the 13 patients who had undergone accurate localization before the operation, the median operative lime was 75 minutes compared with 235 minutes for four patients who did not have an undescended parathyroid adenoma identified before the operation and were examined via a previous transverse cervical incision. All patients were cured of their hyperparathyroidism.
      Conclusions. Undescended parathyroid adenomas were the cause of failed cervical exploration in 17 (7%) of 255 patients, Accurate preoperative localization of these lesions is possible in most cases with a combination of noninvasive and invasive modalities. Successful preoperative localization can convert a prolonged exploration of the neck and mediastinum into a brief, curative procedure with minimal morbidity.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Satava Jr, R.M.
        • Beahrs O.H.
        • Scholz D.A.
        Success rate of cervical exploration for hyperparathyroidism.
        Arch Surg. 1975; 110: 625-628
        • Brennan M.F.
        • Marx S.J.
        • Doppman J.
        • et al.
        Results of reoperation for persistent and recurrent hyperparathyroidism.
        Ann Surg. 1981; 194: 671-676
        • Grant C.S.
        • van Heerden J.A.
        • Charboneau J.W.
        • James E.M.
        • Reading C.C.
        Clinical management of persistent and/or recurrent primary hyperparathyroidism.
        World J Surg. 1986; 10: 555-565
        • Wang C.
        Parathyroid reexploration: a clinical and pathological study of 112 cases.
        Ann Surg. 1977; 186: 140-145
        • Levin K.E.
        • Gooding G.A.W.
        • Okerlund M.
        • et al.
        Localizing studies in patients with persistent or recurrent hyperparathyroidism.
        Surgery. 1987; 102: 917-925
        • Granberg P.-O.
        • Johansson G.
        • Lindvall N.
        • et al.
        Reoperation for primary hyperparathyroidism.
        Am J Surg. 1982; 143: 296-300
        • Edis A.J.
        • Sheedy II, P.F.
        • Beahrs O.H.
        • van Heerden J.A.
        Results of reoperation for hyperparathyroidism, with evaluation of preoperative localization studies.
        Surgery. 1978; 84: 384-393
        • Edis A.J.
        • Purnell D.C.
        • van Heerden J.A.
        The undescended parathymus: an occasional cause of failed neck exploration of hyperparathyroidism.
        Ann Surg. 1979; 190: 64-68
        • Norris E.H.
        The parathyroid glands and the lateral thyroid in man: their morphogenesis, histogenesis, topographic anatomy and prenatal growth.
        Contrib Embryol. 1937; 26: 247
        • Fraker D.L.
        • Doppman J.L.
        • Shawker T.H.
        • Marx S.J.
        • Spiegel A.M.
        • Norton J.A.
        Undescended parathyroid adenoma: an important etiology for failed operations for primary hyperparathyroidism.
        World J Surg. 1990; 14: 342-348
        • Sugg S.L.
        • Fraker D.L.
        • Alexander H.R.
        • et al.
        Prospective evaluation of selective venous sampling.
        Surgery. 1993; 114: 1004-1010
        • Saxe A.W.
        • Brennan M.F.
        Strategy and technique of reoperative parathyroid surgery.
        Surgery. 1981; 89: 417

      13. Buell JF, Fraker DL, Doppman JL, et al. High cervical intravagal hypercellular parathyroid gland as the etiology of severe persistent primary hyperparathyroidism. (in press).

        • Saxe A.W.
        • Brennan M.F.
        Reoperative parathyroid surgery for primary hyperparathyroidism caused by multiple-gland disease: total parathyroidectomy and autotransplantation with cryopreserved tissue.
        Surgery. 1982; 91: 616-621
        • Wang C.A.
        The anatomic basis of parathyroid surgery.
        Ann Surg. 1975; 183: 271-275
        • Akerstrom G.
        • Malmaeus J.
        • Bergstrom R.
        Surgical anatomy of human parathyroid glands.
        Surgery. 1984; 95: 14-21
        • Bruining H.A.
        • van Houten H.
        • Jettmann J.R.
        • Lamberts S.W.J.
        • Birkenhager J.C.
        Results of operative treatment of 615 patients with primary hyperparathyroidism.
        World J Surg. 1981; 5: 85-90
        • McGarity W.C.
        • Goldman A.L.
        Reoperation for primary hyperparathyroidism.
        Ann Surg. 1981; 194: 134-139

      Article info

      Footnotes

      ☆Presented at the Fifteenth Annual Meeting of the American Association of Endocrine Surgeons, Dearborn, Mich., April 17–19, 1994.

      Identification

      DOI: https://doi.org/10.5555/uri:pii:0039606094902933

      Copyright

      © 1994 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX