Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus
Introduction. Primary hyperparathyroidism is rare pathology in children (2–5:100,000). In more than 85% of patients, a single adenoma is present, and its extirpation is usually the only treatment a patient requires. In approximately 15–80% of cases, ectopic mediastinal parathyroid tissue can be foun...
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| Format: | Article |
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Serbian Medical Society
2021-01-01
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| Series: | Srpski Arhiv za Celokupno Lekarstvo |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0370-8179/2021/0370-81792100042J.pdf |
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| author | Jokić Radoica Antić Jelena Vorgučin Ivana Stajević Mila Nikin Zoran Žeravica Radmila Lukić Ivana |
| author_facet | Jokić Radoica Antić Jelena Vorgučin Ivana Stajević Mila Nikin Zoran Žeravica Radmila Lukić Ivana |
| author_sort | Jokić Radoica |
| collection | DOAJ |
| description | Introduction. Primary hyperparathyroidism is rare pathology in children (2–5:100,000). In more than 85% of patients, a single adenoma is present, and its extirpation is usually the only treatment a patient requires. In approximately 15–80% of cases, ectopic mediastinal parathyroid tissue can be found inside the thymus. Case outline. Our patient was a 13-year-old boy, who presented with multiple bone fractures in the previous period of time, and fatigue. Parathyroid hormone levels preoperatively were extremely high (1320 pg/ml – more than 19 times higher than normal). Serum calcium was also elevated (total 3.55 mmol/l; ionized 1.41 mmol/l). He was examined and diagnosed as primary hyperparathyroidism by a pediatric endocrinologist. Imaging procedures for the preoperative localization of parathyroid adenomas were done (99mTc sestamibi scintigraphy and magnetic resonance imaging suggested ectopic mediastinal parathyroid adenoma). The patient underwent video-assisted thoracoscopic surgery procedure. After exploration of the mediastinum and chest, no ectopic parathyroid tissue was found, so total thoracoscopic thymectomy was performed. Final pathological section confirmed parathyroid adenoma inside the thymus. Conclusion. We believe that if no parathyroid tissue is found during surgical exploration of mediastinum, in a child with preoperatively detected parathyroid adenoma in anterior mediastinum, recommendation is to think about possible intrathymic localization and consider removing the thymus. Greater sample size is necessary for higher reliability of this statement. |
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| id | doaj.art-e9bbc97cab86446cbc3f345a812db1d5 |
| institution | Directory Open Access Journal |
| issn | 0370-8179 2406-0895 |
| language | English |
| last_indexed | 2024-12-18T02:21:31Z |
| publishDate | 2021-01-01 |
| publisher | Serbian Medical Society |
| record_format | Article |
| series | Srpski Arhiv za Celokupno Lekarstvo |
| spelling | doaj.art-e9bbc97cab86446cbc3f345a812db1d52022-12-21T21:24:11ZengSerbian Medical SocietySrpski Arhiv za Celokupno Lekarstvo0370-81792406-08952021-01-011495-636536910.2298/SARH200529042J0370-81792100042JVideo-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymusJokić Radoica0Antić Jelena1Vorgučin Ivana2Stajević Mila3https://orcid.org/0000-0002-1793-5174Nikin Zoran4https://orcid.org/0000-0002-5796-8296Žeravica Radmila5Lukić Ivana6Institute for Child and Youth Health Care of Vojvodina, Clinic of Pediatric Surgery, Novi Sad, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, SerbiaInstitute for Child and Youth Health Care of Vojvodina, Clinic of Pediatric Surgery, Novi Sad, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Institute for Child and Youth Health Care of Vojvodina, Pediatric Clinic, Novi Sad, SerbiaDr Vukan Čupić Institute for Mother and Child Health Care of Serbia, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Oncology Institute of Vojvodina, Department of Pathoanatomical and Laboratory Diagnostics, Sremska Kamenica, SerbiaUniversity of Novi Sad, Faculty of Medicine, Novi Sad, Serbia + Clinical Center of Vojvodina, Nuclear Medicine Department, Novi Sad, SerbiaInstitute for Child and Youth Health Care of Vojvodina, Clinic of Pediatric Surgery, Novi Sad, Serbia + University of Novi Sad, Faculty of Medicine, Novi Sad, SerbiaIntroduction. Primary hyperparathyroidism is rare pathology in children (2–5:100,000). In more than 85% of patients, a single adenoma is present, and its extirpation is usually the only treatment a patient requires. In approximately 15–80% of cases, ectopic mediastinal parathyroid tissue can be found inside the thymus. Case outline. Our patient was a 13-year-old boy, who presented with multiple bone fractures in the previous period of time, and fatigue. Parathyroid hormone levels preoperatively were extremely high (1320 pg/ml – more than 19 times higher than normal). Serum calcium was also elevated (total 3.55 mmol/l; ionized 1.41 mmol/l). He was examined and diagnosed as primary hyperparathyroidism by a pediatric endocrinologist. Imaging procedures for the preoperative localization of parathyroid adenomas were done (99mTc sestamibi scintigraphy and magnetic resonance imaging suggested ectopic mediastinal parathyroid adenoma). The patient underwent video-assisted thoracoscopic surgery procedure. After exploration of the mediastinum and chest, no ectopic parathyroid tissue was found, so total thoracoscopic thymectomy was performed. Final pathological section confirmed parathyroid adenoma inside the thymus. Conclusion. We believe that if no parathyroid tissue is found during surgical exploration of mediastinum, in a child with preoperatively detected parathyroid adenoma in anterior mediastinum, recommendation is to think about possible intrathymic localization and consider removing the thymus. Greater sample size is necessary for higher reliability of this statement.http://www.doiserbia.nb.rs/img/doi/0370-8179/2021/0370-81792100042J.pdfprimary hyperparathyroidismvideo-assisted thoracoscopythymectomytc-99m sestamibi parathyroid scanchildren |
| spellingShingle | Jokić Radoica Antić Jelena Vorgučin Ivana Stajević Mila Nikin Zoran Žeravica Radmila Lukić Ivana Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus Srpski Arhiv za Celokupno Lekarstvo primary hyperparathyroidism video-assisted thoracoscopy thymectomy tc-99m sestamibi parathyroid scan children |
| title | Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus |
| title_full | Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus |
| title_fullStr | Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus |
| title_full_unstemmed | Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus |
| title_short | Video-assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus |
| title_sort | video assisted thoracoscopic surgery for primary hyperparathyroidism with ectopic parathyroid adenoma in thymus |
| topic | primary hyperparathyroidism video-assisted thoracoscopy thymectomy tc-99m sestamibi parathyroid scan children |
| url | http://www.doiserbia.nb.rs/img/doi/0370-8179/2021/0370-81792100042J.pdf |
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