Skip to main content
SpringerLink
Log in

The challenge of the middle mediastinal parathyroid

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

In most cases of persistent or recurrent hyperparathyroidism (HPT), the pathological parathyroid (PT) will be in the neck or accessible through the cervical approach, and in only a small percentage will median sternotomy be required. We present 3 cases of persistent HPT where the PT tissue was in the middle mediastinum. We acknowledge that this is a rare occurrence and that it cannot be explained adequately by standard embryological teaching. In cases requiring formal mediastinal exploration, the mediastinal exploration is not complete unless the middle mediastinum is carefully explored to exclude ectopic PT tissue.

Résumé

Dans la plupart des cas d'hyperparathyroïdie (HPT) persistante ou récidivante, la glande parathyroïdienne (PT) pathologique responsable se trouve souvent dans le cou ou est au moins accessible par une incision cervicale. Il est rare qu'une sternotomie médiane soit nécessaire. Nous présentons 3 cas d'HPT persistante dans lesquels la glande PT restante se trouvait dans le médiastin moyen. Nous reconnaissons qu'il s'agit d'une éventualité rare qui ne peut être expliquée par l'embryologie classique. Dans les cas où une exploration médiastinale réglée est nécessaire, il faut, pour être complet, ne pas oublier d'explorer le médiastin moyen pour exclure toute possibilité d'existence de tissu PT ectopique.

Resumen

En la mayoría de los casos de hiperparatiroidismo persistente o recurrente la glándula patológica se encuentra en el cuello o es accessible por un abordaje cervical, y sólo en un mínimo porcentaje se hace necesario realizar esternotomía. Presentamos 3 casos de hiperpartiroidismo persistente en los cuales el tejido paratiroideo anormal fue hallado en el mediastino medio, posterior al arco aórtico pero anterior a la carina y a los bronquios principales. Reconocemos que este es un hallazgo raro y que no puede ser adecuadamente explicado a la luz de los conocimientos embriológicos ordinarios. En casos que requieran exploracíon mediastinal formal, la exploración no puede ser considerada como completa a menos que el mediastino medio sea cuidadosamente inspeccionado a fín de excluir la presencia de tejido paratiroideo ectópico.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bruining, H.A., van Houten, H., Juttman, J.R., Lamberts, S.W.J., Birkenhäger, J.C.: Results of operative treatment of 615 patients with primary hyperparathyroidism. World J. Surg.5:85, 1981

    Google Scholar 

  2. Martin, J.K., van Heerden, J.A., Edis, A.J., Dahlin, D.C.: Persistent postoperative hyperparathyroidism. Surg. Gynecol. Obstet.151:764, 1980

    Google Scholar 

  3. Mundy, G.R., Cove, D.H., Fisken, R.: Primary hyperparathyroidism: Changes in the pattern of clinical presentation. Lancet1:1317, 1980

    Google Scholar 

  4. Satava, R.M., Beahrs, O.H., Scholz, D.A.: Success rate of cervical exploration for hyperparathyroidism. Arch. Surg.110:625, 1975

    Google Scholar 

  5. Thompson, N.W.: Discussion on Results of reoperation for hyperparathyroidism with evaluation of preoperative localization studies. Surgery84:384, 1978

    Google Scholar 

  6. Brennan, M.F., Marx, S.J., Doppman, J.L., Costa, J., Saxe, A., Spiegel, A., Krudy, A., Aurbach, G.: Results of re-operation for persistent or recurrent hyperparathyroidism. Ann. Surg.194:671, 1981

    Google Scholar 

  7. Grant, C.S., van Heerden, J.A., Charboneau, J.W., James, E.M., Reading, C.C.: Clinical management of persistent and/or recurrent primary hyperparathyroidism. World J. Surg.10:555, 1986

    Google Scholar 

  8. Thompson, N.W., Eckhauser, F.E., Harness, J.K.: The anatomy of primary hyperparathyroidism. Surgery92:814, 1982

    Google Scholar 

  9. Norton, J.A., Schneider, P.D., Brennan, M.F.: Median sternptomy in reoperations for primary hyperparathyroidism. World J. Surg9:807, 1985

    Google Scholar 

  10. Wang, C.-A.: Surgical management of primary hyperparathyroidism. Curr. Prob. Surg.22:1, 1985

    Google Scholar 

  11. Stocks, A.E., Hartley, L.C.J.: Hypercalcaemia: The case of the missing adenoma. Med. J. Aust.145:92, 1986

    Google Scholar 

  12. Rossi, R.L., Re Mine, S.G., Clerkin, E.P.: Surg. Clin. North Am.65:187, 1985

    Google Scholar 

  13. Edis, A.J., Sheedy, II, P.F., Beahrs, O.H., van Heerden, J.A.: Results of reoperation for hyperparathyroidism with evaluation of preoperative localization studies. Surgery84:384, 1978

    Google Scholar 

  14. Beazley, R.M., Costa, J., Ketcham, A.S.: Reoperative parathyroid surgery. Am. J. Surg.130:427, 1975

    Google Scholar 

  15. van Vroonhoven, J.J., Muller, H.: Causes of failure in surgical treatment of primary hyperparathyroidism: Lessons from 51 successful reoperations. Br. J. Surg.65:297, 1978

    Google Scholar 

  16. Akerström, J.R., Malmaeus, J., Bergstrom, R.: Surgical anatomy of human parathyroid glands. Surgery95:14, 1984

    Google Scholar 

  17. Wang, C-A.: The anatomic basis of parathyroid surgery. Ann. Surg.183:271, 1976

    Google Scholar 

  18. Edis, A.J., Purnell, D.C., van Heerden, J.A.: The undescended “parathymus”: An occasional cause of failed neck exploration for hyperparathyroidism. Ann. Surg.190:64, 1979

    Google Scholar 

  19. Cohn, K.H., Silen, W.S.: Lessons of parathyroid reoperations. Am. J. Surg.144:511, 1982

    Google Scholar 

  20. Russell, C.F., Grant, C.S., van Heerden, J.A.: Hyperfunctioning supernumerary parathyroid glands: An occasional cause of hyperparathyroidism. Mayo Clin. Proc.57:121, 1982

    Google Scholar 

  21. Scholz, D.A., Purnell, D.C., Woolner, L.B.: Mediastinal hyperfunctioning parathyroid tumours: Review of 14 cases. Ann. Surg.178:173, 1954

    Google Scholar 

  22. Wang, C.-A., Mahaffey, J.E., Axelrod, L., Perlman, J.A.: Hyperfunctioning supernumerary parathyroid glands. Surg. Gynecol. Obstet.148:711, 1979

    Google Scholar 

  23. Hamilton, W.J., Mossman, H.W.: Human Embryology, 4th edition, Cambridge, W. Heffner & Sons, 1972, chapters X (pp. 228–290), XI (pp. 291–376)

    Google Scholar 

  24. Gilmour, J.R.: Embryology of the parathyroid glands and thymus and certain associated rudiments. J. Pathol.45:507, 1937

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital of Wales, Cardiff, Wales, UK

    I. R. Curley F.R.C.S., F.R.A.C.S., M. H. Wheeler M.D., F.R.C.S., N. W. Thompson M.D., F.A.C.S. & C. S. Grant M.D., F.A.C.S.

  2. Department of Surgery, Division of Endocrine Surgery, University of Michigan, Ann Arbor, Michigan, USA

    I. R. Curley F.R.C.S., F.R.A.C.S., M. H. Wheeler M.D., F.R.C.S., N. W. Thompson M.D., F.A.C.S. & C. S. Grant M.D., F.A.C.S.

  3. Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA

    I. R. Curley F.R.C.S., F.R.A.C.S., M. H. Wheeler M.D., F.R.C.S., N. W. Thompson M.D., F.A.C.S. & C. S. Grant M.D., F.A.C.S.

Authors
  1. I. R. Curley F.R.C.S., F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. H. Wheeler M.D., F.R.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. W. Thompson M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. S. Grant M.D., F.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Curley, I.R., Wheeler, M.H., Thompson, N.W. et al. The challenge of the middle mediastinal parathyroid. World J. Surg. 12, 818–822 (1988). https://doi.org/10.1007/BF01655485

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01655485

Keywords

Search

Navigation