Endocrine Abstracts

Parathyromatosis, a rare cause of recurrent hyperparathyroidism, consists of ectopic hyper-functioning parathyroid tissues scattered throughout neck. Two forms of parathyromatosis have been reported, type-1 due to hyperplasia of parathyroid rests from embryologic development and type-2 occurs due to spillage, seeding of parathyroid tissue during parathyroid surgery. Repeated surgery often is necessary. Preoperative diagnosis is rarely made, may be due to lack of awareness of entity.

We present a case of recurrent hyperparathyroidism occurring 2-years after parathyroid surgery in a patient with primary hyperparathyroidism. We attribute this to spillage of tumour cells during previous endoscopic parathyroidectomy. A 55-years old male presented with bony pains and nausea for 1 year. He had focused left superior endoscopic parathyroidectomy done 2-years back for adenoma. Physical examination was unremarkable. The laboratory results showed elevated serum calcium 3.5 mmol/l, PTH 1400 ng/l and 24-h urinary calcium, suggestive of recurrent hyperparathyroidism. Ultrasonography, MIBI and PET scans failed to localise lesion. Possibilities of incomplete removal, hyperplasia, multiple/ectopic adenoma, malignancy and parathyromatosis were considered. On exploration, multiple nodules (<5 mm) were found in the left side neck compartment embedded in strap muscles, sternocliedomastoid, thyroid surface and left central compartment. Opposite parathyroid glands were normal. The surgical procedure included left hemi-thyroidectomy, removal of ipsilateral straps, parts of sternocleidomastoid, berry picking of superficial nodules and clearance of tissue close to entry of ports. Post-op laboratory results showed serum calcium 2.4 mmol/l and undetectable PTH levels (<2.5 ng/l). The histopathology findings indicated parathyromatosis. Serum calcium is normal on 1-year follow up. This is first case report to show parathyromatosis occurring following endoscopic surgery for benign parathyroid adenoma. So, Utmost care should be taken to avoid parathyroid spillage during surgery and make every effort to not rupture parathyroid capsule, even of benign tumour of the gland.