title: Reoperative Parathyroidectomy: Overly Descended Superior Adenoma.
abstract: OBJECTIVE
  To identify the importance of the ectopic, overly descended superior parathyroid adenoma variant and its prevalence in primary and reoperative parathyroid surgery and the implications for successful initial parathyroidectomy.
  
  
  METHODS
  Case series with planned data collection.
  
  
  METHODS
  Tertiary endocrine surgery practice in an academic medical center.
  
  
  METHODS
  An analysis was undertaken of 561 consecutive patients undergoing parathyroid surgery in a tertiary endocrine surgery practice from March 2004 to April 2013. There were 270 patients who had curative primary or reoperative surgery for single-gland parathyroid adenomas during this time. Clinical records, imaging studies, operative reports, and pathology findings were evaluated, and cases from a subset of patients who had an ectopic, overly descended superior parathyroid adenoma were further analyzed. The prevalence of this entity in primary and revision surgeries was calculated.
  
  
  RESULTS
  Among the 270 patients with single-gland parathyroid adenomas, there were 251 primary operations and 19 reoperative procedures referred from outside institutions. An ectopic, overly descended superior parathyroid adenoma was present in 23 (9.2%) primary cases and 4 (21.1%) reoperative cases.
  
  
  CONCLUSIONS
  An overly descended superior parathyroid adenoma is frequently encountered during primary parathyroid surgery. It is more than twice as common in reoperative parathyroidectomy, reflecting the propensity to be missed at the first exploration. Recognition and proper treatment of this entity at the initial operation will reduce the need for revision surgery.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Duke
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, USA.
authors.forename: Hampton M
authors.initials: HM
authors.lastname: Vernon
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, USA dterris@gru.edu.
authors.forename: David J
authors.initials: DJ
authors.lastname: Terris
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery*; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
keywords: ectopic; parathyroid adenoma; parathyroid surgery; parathyroidectomy