title: Mediastinal hyperfunctioning parathyroids: incidence, evolving treatment, and outcome.
abstract: BACKGROUND
  The evaluation and treatment of hyperfunctioning mediastinal parathyroid gland(s) (MPG) is evolving. This study reports our overall experience with MPG in a tertiary referral center.
  
  
  METHODS
  A prospective database of 922 patients undergoing parathyroidectomy by 2 surgeons from 1982 to 2005 was reviewed.
  
  
  RESULTS
  Thirty-two of 922 (3.5%) patients had MPG. Nine (28%) patients had a prior failed parathyroidectomy. Sestamibi and computed tomography scans were correctly positive in 24/28 (86%) and 6/7 (86%) patients, respectively. MPGs were removed via cervical approach in 22 (69%). Eleven of 22 patients had a focused cervical approach. Nine MPGs required a limited sternotomy (n = 3) or a successful radioguided video-assisted thoracoscopic approach (VATS, n = 4) for removal. Two VATS were converted to a full sternotomy. One patient refused surgery. All patients who required sternotomy/VATS had MPGs caudal to the innominate vein. Twenty-nine of 31 (94%) patients were cured. Two are stable on calcimimetics. One patient has permanent hypoparathyroidism.
  
  
  CONCLUSIONS
  Most MPGs can be removed through a cervical approach. Preoperative Sestamibi and computed tomography scans can help the surgeon plan the best initial surgical approach. Those below the innominate vein require a thoracic procedure, preferably a radioguided probe-assisted thoracoscopic resection with intraoperative parathyroid hormone (ioPTH). An alternative to surgical removal is medical treatment.
authors.affiliation: Department of Surgery, Rush University Medical Center, 1725 W. Harrison Street, Ste. 818, Chicago, IL 60612, USA.
authors.forename: Naris
authors.initials: N
authors.lastname: Nilubol
authors.forename: Todd
authors.initials: T
authors.lastname: Beyer
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prinz
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Solorzano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000453:epidemiology / Q000601:surgery*; D015994:Incidence; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods*