Endocrine Abstracts

Introduction: Primary hyperparathyroidism is frequent; it can be ectopic in 11 to 25% of cases, the mediastinal position is the most frequent ectopic position, but the intrapericardial position is exceptional.

Clinical Case: A 58 year old woman with primary hyperparathyroidism complicated by severe osteoporosis. The CT scan and parathyroid scintigraphy reveals a 17 mm parathyroid adenoma in the mediastinal aortopulmonary position. After a first thoracic surgery which was unsuccessful, the patient was treated with injectable then oral bisphosphonates, while waiting for the second surgery done after two years, a second surgery was performed with extirpation of an adenoma between the ascending aorta and the trunk of the pulmonary artery, after opening the pericardium under the aorta. After surgery the patient developed signs of hypocalcaemia immediately after surgery, PTH dropped by more than 50% (from more than 200 to 99 pg/ml), the histological study was in favor of an ectopic parathyroid adenoma. The evolution was marked by a normalization of the phosphocalcic balance.

Discussion: Among the ectopic forms of hyperparathyroidism, the intrapericardial position of a parathyroid tissue is exceptional and difficult to operate, hence the need to entrust the patient to an experienced surgeon.