Abstract
Purpose
Primary hyperparathyroidism (PHPT) is a common endocrine disorder and is usually diagnosed in adults. PHPT due to ectopic parathyroid adenoma in adolescents is rare.
Methods
We describe the case of a 15-year-old boy with PHPT due to ectopic parathyroid adenoma. A review of the literature of PHPT in adolescents was performed, focusing on etiology, clinical presentation, preoperative localization methods, pathology, and treatment.
Results
The patient was successfully treated with surgery and was followed up for 5 years with no signs or symptoms of hyperparathyroidism. By reviewing the literature, only seven cases of PHPT associated with ectopic parathyroid lesions in adolescents have been reported. Parathyroidectomy is the only known curative treatment. Accurate preoperative localization of the target lesion is critical.
Conclusions
This study should raise awareness of the diagnosis and treatment of PHPT due to ectopic parathyroid adenoma/carcinoma in adolescents.
Similar content being viewed by others
References
R. Ciappuccini, J. Morera, P. Pascal, J.P. Rame, N. Heutte, N. Aide, E. Babin, Y. Reznik, S. Bardet, Dual-phase 99 mTc sestamibiscintigraphy with neck and thorax SPECT/CT in primary hyperparathyroidism: a single-institution experience. Clin. Nucl. Med. 37, 223–228 (2012)
D. Rubello, D. Casara, S. Giannini, A. Piotto, L. Dalle Carbonare, C. Pagetta, G. Boni, G. Mariani, P.C. Muzzio, M.R. Pelizzo, Minimally invasive radioguided parathyroidectomy: an attractive therapeutic option for elderly patients with primary hyperparathyroidism. Nucl. Med. Commun. 25(9), 901–908 (2004).
M.D. Walker, S.J. Silverberg, Primary hyperparathyroidism. Nat. Rev. Endocrinol. 14(2), 115–125 (2018)
D.S. Levine, S.M. Wiseman, Fusion imaging for parathyroid localization in primary hyperparathyroidism. Expert Rev. Anticancer Ther. 10(3), 353–363 (2010)
A. Righi, K. Dimosthenous, J. Mize, Mediastinal parathyroid carcinoma with tumor implants in a child: a unique occurrence. Int. J. Surg. Pathol. 16(4), 458–460 (2008)
AACE/AAES Task Force on Primary Hyperparathyroidism, The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr. Pract. 11(1), 49–54 (2005)
V.K. Dhillon, P. Pitukcheewanont, M. Yeh, D. Maceri, Identifying an ectopic parathyroid adenoma using 4DCT in a pediatric patient with persistent primary hyperparathyroidism. Case Rep. Otolaryngol. 2013, 676039 (2013). https://doi.org/10.1155/2013/676039
Y. Minamiya, H. Saito, M. Ito, S. Motoyama, Y. Katayose, J. Ogawa, Radio-guided thoracoscopic surgery with (99m)Tc-methoxy-isobutylisonitrile for treating an ectopic mediastinal parathyroid adenoma in an adolescent girl. Gen. Thorac. Cardiovasc. Surg. 57(12), 657–659 (2009)
C.C. Li, C. Yang, S. Wang, J. Zhang, X.R. Kong, J. Ouyang, A 10-year retrospective study of primary hyperparathyroidism in children. Exp. Clin. Endocrinol. Diabetes 120(4), 229–233 (2012)
A.F. Saad, L.D. Pacheco, M.M. Costantine, Management of ectopic parathyroid adenoma in pregnancy. Obstet. Gynecol. 124(2 Pt 2 Suppl 1), 478–480 (2014)
T.J. Birdas, R.J. Keenan, Mediastinal parathyroid adenoma. Ann. Thorac. Surg. 79(3), 1097 (2005)
A.G. Fiedler, C. Rossi, C.A. Gingalewski, Parathyroid carcinoma in a child: an unusual case of an ectopically located malignant parathyroid gland with tumor invading the thymus. J. Pediatr. Surg. 44(8), 1649–1652 (2009)
M. Iihara, R. Suzuki, A. Kawamata, K. Horiuchi, T. Okamoto, Thoracoscopic removal of mediastinal parathyroid lesions: selection of surgical approach and pitfalls of preoperative and intraoperative localization. World J. Surg. 36(6), 1327–1334 (2012)
A.E. Stephen, M. Mannstadt, R.A. Hodin, Indications for surgical management of hyperparathyroidism: a review. JAMA Surg. 152(9), 878–882 (2017)
A.D. Toft, Surgery for primary hyperparathyroidism—sooner rather than later. Lancet 355(9214), 1478–1479 (2000)
A. Sitges-Serra, A. Bergenfelz, Clinical update: sporadic primary hyperparathyroidism. Lancet 370(9586), 468–470 (2007)
E. Hindie, O. Ugur, D. Fuster, M. O'Doherty, G. Grassetto, P. Ureña, A. Kettle, S.A. Gulec, F. Pons, D. Rubello; Parathyroid Task Group of the EANM, 2009 EANM parathyroid guidelines. Eur. J. Nucl. Med. Mol. Imaging 36(7), 1201–1216 (2009)
G.G. Callender, E.G. Grubbs, T. Vu, W.L. Hofstetter, J.B. Fleming, K.L. Woodburn, J.E. Lee, D.B. Evans, N.D. Perrier, The fallen one: the inferior parathyroid gland that descends into the mediastinum. J. Am. Coll. Surg. 208(5), 887–893 (2009)
J.P. Bilezikian, L. Bandeira, A. Khan, N.E. Cusano, Hyperparathyroidism. Lancet 391(10116), 168–178 (2018)
W.D. Fraser, Hyperparathyroidism. Lancet 374(9684), 145–158 (2009)
D.P. Macfarlane, N. Yu, G.P. Leese, Subclinical and asymptomatic parathyroid disease: implications of emerging data. Lancet Diabetes Endocrinol. 1(4), 329–340 (2013)
M.A. Koljevic, M.M. Jankovic, I. Markovic, G. Pupić, R. Džodić, A.B. Delaloye, Parathyroid dual tracer subtraction scintigraphy: small regions method for quantitative assessment of parathyroid adenoma uptake. Ann. Nucl. Med. 28(8), 736–745 (2014)
K.A. Zanocco, M.W. Yeh, Primary hyperparathyroidism: effects on bone health. Endocrinol. Metab. Clin. North Am. 46(1), 87–104 (2017)
J. Taki, H. Sumiya, H. Tsuchiya, K. Tomita, A. Nonomura, N. Tonami, Evaluating benign and malignant bone and soft-tissue lesions with technetium-99m-MIBI scintigraphy. J. Nucl. Med. 38(4), 501–506 (1997)
J. Hu, K.Y. Ngiam, R. Parameswaran, Mediastinal parathyroid adenomas and their surgical implications. Ann. R. Coll. Surg. Engl. 97(4), 259–261 (2015)
I.A.S. Elhelf, J.C. Kademian, T. Moritani, A.E. Capizzano, B. Policeni, J. Maley, Ectopic mediastinal parathyroid adenoma localized with four-dimensional CT: a case report. Radiol. Case Rep. 12(2), 247–250 (2017)
R. Soler, A. Bargiela, F. Cordido, C. Aguilera, R. Argüeso, I. Cao, MRI of mediastinal parathyroid cystic adenoma causing hyperparathyroidism. J. Comput. Assist. Tomogr. 20(1), 166–168 (1996)
E.L. Kaplan, T. Yashiro, G. Salti, Primary hyperparathyroidism in the 1990s. Choice of surgical procedures for this disease. Ann. Surg. 215(4), 300–317 (1992)
D.M. Caporale, A. Bobbio, R. Accordino, L. Ampollini, E. Internullo, L. Cattelani, P. Carbognani, M. Rusca, Ectopic mediastinal parathyroid adenoma. Acta Biomed. 74(3), 157–159 (2003)
M. Mehrabibahar, Z. Mousavi, R. Sadeghi, P. Layegh, M. Nouri, M. Asadi, Feasibility and safety of minimally invasive radioguided parathyroidectomy using very low intraoperative dose of Tc-99m MIBI. Int. J. Surg. 39, 229–233 (2017)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent
Written informed consent was obtained from the patient and his parents for publication of this case report and any accompanying images.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Liu, X., Sun, L., Shao, M. et al. Primary hyperparathyroidism due to ectopic parathyroid adenoma in an adolescent: a case report and review of the literature. Endocrine 64, 38–42 (2019). https://doi.org/10.1007/s12020-019-01875-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-019-01875-3