Mediastinal hyperfunctioning parathyroids: incidence, evolving treatment, and outcome

Nilubol, Naris; Beyer, Todd; Prinz, Richard A.; Solorzano, Carmen C.

doi:10.1016/j.amjsurg.2006.11.019

« Previous Next »The American Journal of Surgery
Volume 194, Issue 1 , Pages 53-56, July 2007

Mediastinal hyperfunctioning parathyroids: incidence, evolving treatment, and outcome

Presented at the 49th Annual Meeting of the Midwest Surgical Association, Mackinac Island, MI, August 5–9, 2006

Naris Nilubol, M.D.
- Department of Surgery, Rush University Medical Center, 1725 W. Harrison Street, Ste. 818, Chicago, IL 60612, USA
Todd Beyer, M.D.
- Department of Surgery, Rush University Medical Center, 1725 W. Harrison Street, Ste. 818, Chicago, IL 60612, USA
Richard A. Prinz, M.D.
- Department of Surgery, Rush University Medical Center, 1725 W. Harrison Street, Ste. 818, Chicago, IL 60612, USA
Carmen C. Solorzano, M.D.
- Department of Surgery, Rush University Medical Center, 1725 W. Harrison Street, Ste. 818, Chicago, IL 60612, USA
- Department of Surgery, University of Miami, 1475 NW 12th Ave., Room 3550, Miami, FL 33136, USA
- Corresponding author. Sylvester Comprehensive Cancer Center, Department of Surgery (M-875), 1475 N.W. 12th Ave, Room 3550, Miami, FL 33136. Tel.: +1-305-243-4211 (ext. 3); fax: +1-305-243-4221.

Received 14 August 2006; received in revised form 6 November 2006

Abstract

Background

The evaluation and treatment of hyperfunctioning mediastinal parathyroid gland(s) (MPG) is evolving. This study reports our overall experience with MPG in a tertiary referral center.

Methods

A prospective database of 922 patients undergoing parathyroidectomy by 2 surgeons from 1982 to 2005 was reviewed.

Results

Thirty-two of 922 (3.5%) patients had MPG. Nine (28%) patients had a prior failed parathyroidectomy. Sestamibi and computed tomography scans were correctly positive in 24/28 (86%) and 6/7 (86%) patients, respectively. MPGs were removed via cervical approach in 22 (69%). Eleven of 22 patients had a focused cervical approach. Nine MPGs required a limited sternotomy (n = 3) or a successful radioguided video-assisted thoracoscopic approach (VATS, n = 4) for removal. Two VATS were converted to a full sternotomy. One patient refused surgery. All patients who required sternotomy/VATS had MPGs caudal to the innominate vein. Twenty-nine of 31(94%) patients were cured. Two are stable on calcimimetics. One patient has permanent hypoparathyroidism.

Conclusions

Most MPGs can be removed through a cervical approach. Preoperative Sestamibi and computed tomography scans can help the surgeon plan the best initial surgical approach. Those below the innominate vein require a thoracic procedure, preferably a radioguided probe-assisted thoracoscopic resection with intraoperative parathyroid hormone (ioPTH). An alternative to surgical removal is medical treatment.

Keywords: Mediastinal, Parathyroid, Thoracoscopy, Radioguided, Parathyroidectomy, Sternotomy