Localization of ectopic and supernumerary parathyroid glands in patients with secondary and tertiary hyperparathyroidism: surgical description and correlation with preoperative ultrasonography and Tc99m-Sestamibi scintigraphy

• Published in: Brazilian journal of otorhinolaryngology Vol. 80; no. 1; pp. 29 - 34
• Main Authors: Andrade, José Santos Cruz de, Mangussi-Gomes, João Paulo, Rocha, Lillian Andrade da, Ohe, Monique Nakayama, Rosano, Marcello, das Neves, Murilo Catafesta, Santos, Rodrigo de Oliveira
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier 01.01.2014
• Subjects: Adult; Aged; Choristoma - diagnostic imaging; Choristoma - pathology; Cross-Sectional Studies; Female; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - surgery; Kidney Failure, Chronic - complications; Male; Middle Aged; Original article; Parathyroid Glands - abnormalities; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Sestamibi; Treatment Failure; Ultrasonography; Young Adult
• ISSN: 1808-8694; 1808-8686
• DOI: 10.5935/1808-8694.20140008

Hyperparathyroidism is an expected metabolic consequence of chronic kidney disease (CKD). Ectopic and/or supernumerary parathyroid glands (PT) may be the cause of surgical failure in patients undergoing total parathyroidectomy (PTX). To define the locations of ectopic and supernumerary PT in patients with renal hyperparathyroidism and to correlate intraoperative findings with preoperative tests. A retrospective study was conducted with 166 patients submitted to PTX. The location of PT during surgery was recorded and classified as eutopic or ectopic. The preoperative localizations of PT found by ultrasonography (USG) and Tc99m-Sestamibi scintigraphy (MIBI) were subsequently compared with intraoperative findings. In the 166 patients studied, 664 PT were found. Five-hundred-seventy-seven (86.4%) glands were classified as eutopic and 91(13.6%) as ectopic. Eight supernumerary PT were found. The most common sites of ectopic PT were in the retroesophageal and thymic regions. Taken together, USG and MIBI did not identify 56 (61.5%) ectopic glands. MIBI was positive for 69,7% of all ectopic glands located in the mediastinal and thymic regions. The presence of ectopic and supernumerary PT in patients with renal hyperparathyroidism is significant. Although preoperative imaging tests did not locate most of ectopic glands, MIBI may be important for identifying ectopic PT in the mediastinal and thymic regions.