ECE2014 Poster Presentations Clinical case reports Thyroid/Others (72 abstracts)
Primary hyperparathyroidism caused by mediastinum located ectopic parathyroid adenoma resected by video-assisted thoracic surgery
Narin Nasiroglu Imga 1 , Ozgur Karakurt 2 , Berçem Aycicek Dogan 1 , Zeynep Karabulut 3 , Yasemin Tutuncu 1 , Dilek Berker 1 , Bülent Kocer 2 & Serdar Guler 1
1Department of Endocrinology, Ankara Numune Education and Research Hospital, Ankara, Turkey; 2Department of Thoracic Surgery, Ankara Numune Education and Research Hospital, Ankara, Turkey; 3Department of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey.
Introduction: Ectopic parathyroid adenomas are detected 16% of patients operated for primary hyperparathyroidism and 22% of them may be located in the anterosuperior mediastinal region. Herein we present a rare case of primary hyperparathyroidism with severe long-term elevated parathormone (PTH) levels due to ectopic parathyroid adenoma in mediastinal region that was successfully treated by using video-assisted thoracic surgery (VATS).
Case report: A 38-year-old female admitted to our clinic with long-term complaints of severe hip pain and gait disturbance. In laboratory tests, serum calcium (Ca): 11.64 mg/dl (8.5–10.5), alkaline phosphatase (ALP): 764 U/l (35–105), phosphorus: 1.51 mg/dl (2.5–4.5), PTH 1385 pg/ml (15–65). The bone mineral density showed osteoporosis. X-ray radiography demonstrated extensive osteoporosis in the vertebrae, humerus, and femur. Urinary USG showed cortical millimetric calcifications in interpolar part of left kidney. No adenoma or hyperplasia was seen on neck USG. Parathyroid SPECT demonstrated a 27×48 mm lesion starting from first costosternal joint on the left mediastinal midline surrounding the aortic arch and reaching to parasternal area. Thorax CT revealed a 46×20×31 mm hypodense lesion located anterior to aortic arch in anterior mediastinal fatty tissue. Parathyroid adenectomy was performed via left VATS by the Thoracic Surgery Department. Postoperative 1st day both Ca: 6.79 mg/dl and PTH: 150 pg/ml levels were decreased and phosphorus level was return to normal range. Hungry bone syndrome (HBS) occured 48 h after surgery. Calcium and phosphorus levels were improved in 10 days by supplementation calcium and alfacalcidiol.
Conclusion: This is a rare case due to severe osteoporosis by large ectopic parathyroid adenoma in the mediastinum in a premenopausal woman that success recovery achieved via VATS. The cosmetic results of VATS is superior to sternotomy or thoracotomy and morbidity rate is low.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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