title: Multiple ectopic parathyroid adenomas.
abstract: BACKGROUND
  Primary hyperparathyroidism is the most common cause of hypercalcemia in unselected patients. The ectopic gland locations should be known for appropriate surgical exploration and for avoiding subsequent re-exploration that would represent higher morbidity. Multiple ectopic glands are rare and present a particular challenge in parathyroid surgery.
  
  
  METHODS
  A 65-year-old female presented with nephrolithiasis. Her serum total calcium was found to be elevated. The diagnosis of primary hyperparathyroidism was confirmed by the elevated serum intact parathyroid hormone levels. Ultrasound was only successful in localizing one adenoma in the lower right gland. Technetium sestamibi scanning correctly localized the same adenoma and showed another contralateral image, lateral to the thyroid cartilage. Fiber optic laryngoscopy showed an extrinsic mass pushing against the lateral and posterior walls of the left pyriform sinus. Resonance imaging revealed a soft tissue mass.
  
  
  RESULTS
  The patient underwent bilateral neck exploration. Histopathological examination confirmed the diagnosis of parathyroid double adenomas. The late-stage postoperative checkups were normal.
  
  
  CONCLUSIONS
  Routine bilateral neck surgery should be performed as a rule. We use ultrasound and technetium sestamibi scanning as a routine for preoperative localization studies. It is helpful to have an experienced surgeon for the localization.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery of Universidade Metropolitana de Santos (Unimes), Hospital Ana Costa, Santos, São Paulo, Brazil. dedivitis.hns@uol.com.br
authors.forename: Rogério Aparecido
authors.initials: RA
authors.lastname: Dedivitis
authors.forename: André Vicente
authors.initials: AV
authors.lastname: Guimarães
authors.forename: Gustavo Bastos de Goes
authors.initials: GB
authors.lastname: Pontes
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis*; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000150:complications; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000175:diagnosis*; D010282:Parathyroid Neoplasms / Q000150:complications / Q000175:diagnosis*