title: Ectopic and extranumerary parathyroid glands location in patients with hyperparathyroidism secondary to end stage renal disease.
abstract: 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.
authors: Postgraduation Program in Endocrinology, Universidade Federal do Rio de Janeiro, Brazil. elainemariagomes@globo.com
authors: Elaine Maria Santos
authors: EM
authors: Gomes
authors: Reinaldo Cavalcante
authors: RC
authors: Nunes
authors: Paulo Gustavo Sampaio
authors: PG
authors: Lacativa
authors: Mirella Hansen de
authors: MH
authors: Almeida
authors: Felipe Malzac
authors: FM
authors: Franco
authors: Christianne Toledo Souza
authors: CT
authors: Leal
authors: Pedro José de Mattos
authors: PJ
authors: Patrício Filho
authors: Maria Lucia Fleiuss
authors: ML
authors: Farias
authors: Manuel Domingos da Cruz
authors: MD
authors: Gonçalves
mesh_terms: 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
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi