title: Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland--case report and review.
abstract: Primary hyperparathyroidism (PHPT) is a common endocrine disorder that mainly affects middle-aged women. Patients are usually asymptomatic. The disease might be ascribable to hyperplasia, carcinoma, and single or multiple adenomas. PHPT may be sporadic or familial, the latter comprising multiple endocrine neoplasia type 1 or 2A, familial benign hypocalciuria hypercalcemia, and hyperparathyroidism-jaw tumor syndrome. The most common causes for persistent PHPT are multiglandular disease, and missed abnormal ectopic or orthotopic parathyroid glands. Imaging localization studies should precede a new surgical intervention. Ectopic parathyroid glands are rarely located at the aortopulmonary window. For diagnosis confirmation, (99m)Tc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform (99m)Tc-sestamibi followed by thoracic CT or MRI. Parathyroidectomy may be performed by means of median sternotomy, thoracotomy, or video-assisted thoracoscopy. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the aortopulmonary window. As the investigation necessary to clarify the etiology of recurrent nephrolithiasis proceeded, the diagnosis of PHPT was determined. The patient underwent subtotal parathyroidectomy; nevertheless, PHPT persisted. Genetic syndromes that could account for this condition were excluded. Imaging studies available at that time were not able to locate abnormal glands; moreover, the patient refused to undergo surgical exploration. Later, the patient underwent (99m)Tc-sestamibi SPECT/CT, which revealed a parathyroid gland at the aortopulmonary window.
authors.affiliation: Endocrinology, Diabetes and Metabolism Department, Coimbra's University Hospital, Coimbra, Portugal. sofiamgouveia@gmail.com
authors.forename: Sofia
authors.initials: S
authors.lastname: Gouveia
authors.forename: Dírcea
authors.initials: D
authors.lastname: Rodrigues
authors.forename: Luísa
authors.initials: L
authors.lastname: Barros
authors.forename: Cristina
authors.initials: C
authors.lastname: Ribeiro
authors.forename: Anabela
authors.initials: A
authors.lastname: Albuquerque
authors.forename: Gracinda
authors.initials: G
authors.lastname: Costa
authors.forename: Manuela
authors.initials: M
authors.lastname: Carvalheiro
mesh_terms: D000328:Adult; D002828:Choristoma / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000209:etiology; D010280:Parathyroid Glands; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D013959:Thyroid Diseases / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi