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Primary hyperparathyroidism due to ectopic parathyroid adenoma in an adolescent: a case report and review of the literature

  • Endocrine surgery
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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.

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References

  1. 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)

    Article  PubMed  Google Scholar 

  2. 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).

    Article  PubMed  Google Scholar 

  3. M.D. Walker, S.J. Silverberg, Primary hyperparathyroidism. Nat. Rev. Endocrinol. 14(2), 115–125 (2018)

    Article  CAS  PubMed  Google Scholar 

  4. D.S. Levine, S.M. Wiseman, Fusion imaging for parathyroid localization in primary hyperparathyroidism. Expert Rev. Anticancer Ther. 10(3), 353–363 (2010)

    Article  PubMed  Google Scholar 

  5. 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)

    Article  PubMed  Google Scholar 

  6. 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)

    Article  Google Scholar 

  7. 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

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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)

    Article  PubMed  Google Scholar 

  9. 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)

    Article  CAS  PubMed  Google Scholar 

  10. 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)

    Article  PubMed  Google Scholar 

  11. T.J. Birdas, R.J. Keenan, Mediastinal parathyroid adenoma. Ann. Thorac. Surg. 79(3), 1097 (2005)

    Article  PubMed  Google Scholar 

  12. 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)

    Article  PubMed  Google Scholar 

  13. 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)

    Article  PubMed  Google Scholar 

  14. A.E. Stephen, M. Mannstadt, R.A. Hodin, Indications for surgical management of hyperparathyroidism: a review. JAMA Surg. 152(9), 878–882 (2017)

    Article  PubMed  Google Scholar 

  15. A.D. Toft, Surgery for primary hyperparathyroidism—sooner rather than later. Lancet 355(9214), 1478–1479 (2000)

    Article  CAS  PubMed  Google Scholar 

  16. A. Sitges-Serra, A. Bergenfelz, Clinical update: sporadic primary hyperparathyroidism. Lancet 370(9586), 468–470 (2007)

    Article  PubMed  Google Scholar 

  17. 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)

    Article  PubMed  Google Scholar 

  18. 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)

    Article  PubMed  Google Scholar 

  19. J.P. Bilezikian, L. Bandeira, A. Khan, N.E. Cusano, Hyperparathyroidism. Lancet 391(10116), 168–178 (2018)

    Article  CAS  PubMed  Google Scholar 

  20. W.D. Fraser, Hyperparathyroidism. Lancet 374(9684), 145–158 (2009)

    Article  CAS  Google Scholar 

  21. 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)

    Article  PubMed  Google Scholar 

  22. 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)

    Article  CAS  Google Scholar 

  23. K.A. Zanocco, M.W. Yeh, Primary hyperparathyroidism: effects on bone health. Endocrinol. Metab. Clin. North Am. 46(1), 87–104 (2017)

    Article  PubMed  Google Scholar 

  24. 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)

    CAS  PubMed  Google Scholar 

  25. J. Hu, K.Y. Ngiam, R. Parameswaran, Mediastinal parathyroid adenomas and their surgical implications. Ann. R. Coll. Surg. Engl. 97(4), 259–261 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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)

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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)

    Article  CAS  PubMed  Google Scholar 

  28. 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)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. 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)

    PubMed  Google Scholar 

  30. 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)

    Article  PubMed  Google Scholar 

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Author notes

  1. These authors contributed equally: Xiangli Liu, Lei Sun

Authors and Affiliations

  1. Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China

    Xiangli Liu, Lei Sun, Mingrui Shao, PeiWen Li, Wenke Liu, Xinyu Zhang, Lin Zhang & Wenya Li

  2. Department of Thoracic Surgery, Meihekou City Central Hospital, Meihekou, Jilin Province, China

    Yingjun Ma

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  1. Xiangli Liu
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Correspondence to Wenya Li.

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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

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  • DOI: https://doi.org/10.1007/s12020-019-01875-3

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