Partial Sternotomy Application in Mediastinal Parathyroid Adenomas

Abstract

Background: Solitary parathyroid adenomas are the most common cause of primary hyperparathyroidism. Generally neck exploration is adequate for parathyroid adenoma surgery, however some of them aren’t accessible using a cervical approach and sternotomy or thoracotomy can be required. In this study we present surgical application of eight cases with mediastinal parathyroid adenoma.

Material and Methods: Between Jan 2006 - Mar 2018, eight patients who underwent partial sternotomy for mediastinal parathyroid adenoma in our clinic were included in the study. Patients' datas were retrospectively reviewed. Blood tests, radiographic and scintigraphic methods were performed and the results were reviewed. Localization of mediastinal parathyroid adenoma, performed treatment methods and prognosis were evaluated.

Results:  Seven of the cases were female (87.5%) and the mean age was found to be 49.7 years (range: 30-64 years). Bone pain what’s the most common symptom. All of the patients experienced hypercalcemia and hyperparathyroidia. PTH and Ca values returned to normal in postoperative period. No recurrent or consistent hyperparathyroidism was seen during follow-up period. No postsurgical morbidity or mortality developed.

Conclusion: We claimed that partial sternotomy is a safe and adequate method for removing ectopic mediastinal parathyroid adenomas.

Keywords

• Mediastinal Parathyroid Adenomas,surgery,Partial Sternotomy

Mediastinal Paratiroid Adenomlarında Parsiyel Sternotomi Uygulaması

Abstract

Amaç: Primer hiperparatiroidinin en sık nedeni soliter paratiroid adenomlarıdır. Genellikle boyun cerrahisi paratiroid adenomun çıkarılması için yeterlidir, ancak bazılarının servikal bir yaklaşımla ulaşılması mümkün değildir ve sternotomi veya torakotomi gerekebilir. Bu çalışmada mediastinal paratiroid adenomlu sekiz olgunun cerrahi uygulamasını sunduk.

Gereç ve Yöntemler: Ocak 2006- Mart 2018 tarihleri arasında kliniğimizde mediastinal paratiroid adenomu nedeniyle parsiyel sternotomi uygulanan sekiz hasta çalışmaya alındı. Hastaların verileri retrospektif olarak incelendi. Çalışılan kan testleri, radyografik ve sintigrafik yöntemler ve sonuçlar gözden geçirildi. Mediastinal paratiroid adenomunun lokalizasyonu, uygulanan tedavi yöntemleri ve prognozları değerlendirildi.

Bulgular: Olguların 7'si kadın (% 87.5) ve yaş ortalaması 49.7 (30-64) idi. Kemik ağrısı en sık görülen semptomdu. Tüm hastalarda hiperkalsemi ve hiperparatiroidi vardı. Postoperatif dönemde Parathormon (PTH) ve Ca değerleri normale döndü. Takip süresince tekrarlayan veya kalıcı hiperparatiroidizm görülmedi. Cerrahi sonrası morbidite veya mortalite gelişmedi.

Sonuç: Parsiyel sternotomi ektopik mediastinal paratiroid adenomlarını gidermek için güvenli ve yeterli bir yöntem olduğunu düşünmekteyiz.

Anahtar Kelimeler: Mediastinal Paratiroid Adenom, Cerrahi, Parsiyel Sternotomi

Keywords

• Mediastinal Paratiroid Adenom,Cerrahi,Parsiyel Sternotomi

References

1. 1. Linhartova M, Mitas L, Stary K. Rare case of a giant parathyroid adenoma. Rozhl Chir. Winter 2016; 95: 453-56.
2. 2. Lorberboym M, Minski I, Macadziob S et al. Incremental diagnostic value of preoperative 99mTc-MIBI SPECT in patients with a parathyroid adenoma. J Nucl Med 2003; 44: 904–08.
3. 3. Ward AF, Lee T, Ogilvie JB, Patel KN, Hiotis K, Bizekis C, Zervos M. Robot-assisted complete thymectomy for mediastinal ectopic parathyroid adenomas in primary hyperparathyroidism. J Robot Surg 2017; 11: 163-69.
4. 4. Casara D, Rubello D, Piotto A, Pelizzo MR. 99mTc-MIBI radio-guided minimally invasive parathyroid surgery planned on the basis of a preoperative combined 99mTc-pertechnetate/99mTc-MIBI and ultrasound imaging protocol. Eur J Nucl Med 2000; 27: 1300–04.
5. 5. Al-Mashat F, Sibiany A, Faleh D, Kary K, Alfi AY, El-Lakany MM. Mediastinal parathyroid adenoma. Saudi J Kidney Dis Transpl 2009; 20: 826-30.
6. 6. Downey NJ, McGuigan JA, Dolan SJ, Russell CF. Median sternotomy for parathyroid adenoma. Ir J Med Sci 1999; 168: 13-16.
7. 7. Uludag M, Isgor A, Yetkin G, Atay M, Kebudi A, Akgun I. Supernumerary ectopic parathyroid glands. Persistent hyperparathyroidism due to mediastinal parathyroid adenoma localized by preoperative single photon emission computed tomography and intraoperative gamma probe application. Hormones (Athens) 2009; 8: 144-49.
8. 8. Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands. Surgery 1984; 95: 14-21.

9. 9. Dinçer SI, Demir A, Kara HV, Günlüoglu MZ. Thoracoscopic removal of a maternal mediastinal ectopic parathyroid adenoma causing neonatal hypocalcemia: a case report. Ann Thorac Cardiovasc Surg 2008; 14: 325-28.
10. 10. Akerstrom G, Malmaeus J, Bergstrom R. Surgical anatomy of human parathyroid glands. Surgery 1984; 95: 14-21.
11. 11. Doherty GM, Doppman JL, Miller DL et al. Results of a multidisciplinary strategy for management of mediastinal parathyroid adenoma as a cause of persistent primary hyperparathyroidism. Ann Surg 1992; 215: 101–06.
12. 12. Palma G, Giordano R, Russolillo V et al. Anterolateral minithoracotomies for the radical correction of congenital heart diseases. Tex Heart Inst J 2009; 36: 575-79.
13. 13. Chae AW, Perricone A, Brumund KT, Bouvet M. Outpatient video-assisted thoracoscopic surgery (VATS) for ectopic mediastinal parathyroid adenoma: a case report and review of the literature. J Laparoendosc Adv Surg Tech A 2008; 18: 383-90.
14. 14. Ismail M, Maza S, Swierzy M, Tsilimparis N, Rogalla P, Sandrock D, Ruckert RI, Muller J. M. and Ruckert J. C. Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system. British Journal of Surgery 2010; 97: 337–43.
15. 15. Sameh SM, Cassivi SD, Allen MS, Deschamps C, Nichols FC, Shen KR, and Wigle DA. Minimally Invasive Resection for Mediastinal Ectopic Parathyroid Glands. Ann Thorac Surg 2013; 96: 1229–33.