title: Localization of ectopic and supernumerary parathyroid glands in patients with secondary and tertiary hyperparathyroidism: surgical description and correlation with preoperative ultrasonography and Tc99m-Sestamibi scintigraphy.
abstract: BACKGROUND
  Hyperparathyroidism is an expected metabolic consequence of chronic kidney disease (CKD). Ectopic and/or supernumerary parathyroid glands (PT) may be the cause of surgical failure in patients undergoing total parathyroidectomy (PTX).
  
  
  OBJECTIVE
  To define the locations of ectopic and supernumerary PT in patients with renal hyperparathyroidism and to correlate intraoperative findings with preoperative tests.
  
  
  METHODS
  A retrospective study was conducted with 166 patients submitted to PTX. The location of PT during surgery was recorded and classified as eutopic or ectopic. The preoperative localizations of PT found by ultrasonography (USG) and Tc99m-Sestamibi scintigraphy (MIBI) were subsequently compared with intraoperative findings.
  
  
  RESULTS
  In the 166 patients studied, 664 PT were found. Five-hundred-seventy-seven (86.4%) glands were classified as eutopic and 91(13.6%) as ectopic. Eight supernumerary PT were found. The most common sites of ectopic PT were in the retroesophageal and thymic regions. Taken together, USG and MIBI did not identify 56 (61.5%) ectopic glands. MIBI was positive for 69,7% of all ectopic glands located in the mediastinal and thymic regions.
  
  
  CONCLUSIONS
  The presence of ectopic and supernumerary PT in patients with renal hyperparathyroidism is significant. Although preoperative imaging tests did not locate most of ectopic glands, MIBI may be important for identifying ectopic PT in the mediastinal and thymic regions.
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil.
authors.forename: José Santos Cruz de
authors.initials: JS
authors.lastname: Andrade
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil.
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Mangussi-Gomes
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Nefrologia, São PauloSP, Brasil, Departamento de Nefrologia, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil.
authors.forename: Lillian Andrade da
authors.initials: LA
authors.lastname: Rocha
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Endocrinologia Clínica, São PauloSP, Brasil, Departamento de Endocrinologia Clínica, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil.
authors.forename: Monique Nakayama
authors.initials: MN
authors.lastname: Ohe
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil.
authors.forename: Marcello
authors.initials: M
authors.lastname: Rosano
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil.
authors.forename: Murilo Catafesta
authors.initials: MC
authors.lastname: das Neves
authors.affiliation: Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São PauloSP, Brasil, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo / Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP, Brasil.
authors.forename: Rodrigo de Oliveira
authors.initials: Rde O
authors.lastname: Santos
mesh_terms: D000328:Adult; D000368:Aged; D002828:Choristoma / Q000000981:diagnostic imaging / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000002:abnormalities*; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D017211:Treatment Failure; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi