Ectopic and extranumerary parathyroid glands location in patients with hyperparathyroidism secondary to end stage renal disease.
Supranumerary or ectopic parathyroid glands are the main cause of persistent hyperparathyroidism (HPT) in patients with end stage renal disease (ESRD) submitted to parathyroidectomy (PTx).


OBJECTIVE
To evaluate the prevalence and location of parathyroid glands in these patients.


METHODS
Thirty-five patients with ESRD and severe secondary hyperparathyroidism (HPT2) had been submitted to total PTx at HUCFF from December 2001 to July 2005. Surgery was always performed by the same surgeon, who described in details the location of the glands.


RESULTS
Sixteen patients (45.7%) had ectopic glands, which were also extranumerary in five of them (14.3%). The most common locations were the thyroid parenchyma (33.3%), thyroid-thymus conduit (18.5%), and thymus (14.8%). Before PTx, the sensibility of ultrasonography and scintigraphy with technetium-99m Sestamibi was low (48.3% and 35.3%, respectively). Moreover, 51.4% of the nodules found at US were thyroid nodules. However, 99mTc-Sestamibi was useful to identify ectopic glands in those two patients with persistent HPT after PTx.


CONCLUSIONS
The presence of extranumerary and ectopic parathyroid glands in HPT2 is sufficiently important to justify their exhaustive search. As the preoperative image exams present low sensibility to locate them, it is necessary to develop an exploratory routine embracing the most common sites of location.
Gomes
Elaine Maria Santos
EM
Postgraduation Program in Endocrinology, Universidade Federal do Rio de Janeiro, Brazil. elainemariagomes@globo.com
Nunes
Reinaldo Cavalcante
RC
Lacativa
Paulo Gustavo Sampaio
PG
Almeida
Mirella Hansen de
MH
Franco
Felipe Malzac
FM
Leal
Christianne Toledo Souza
CT
Patrício Filho
Pedro José de Mattos
PJ
Farias
Maria Lucia Fleiuss
ML
Gonçalves
Manuel Domingos da Cruz
MD
D000328:Adult; D000368:Aged; D002828:Choristoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013950:Thymus Gland; D013959:Thyroid Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery
D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi