Recurrent hyperparathyroidism: A sixth mediastinal parathyroid gland.

We present the case of a 71-year-old woman with recurrent hyperparathyroidism. She underwent first a subtotal resection of the parathyroid glands associated with subtotal thyroidectomy in the setting of primary hyperparathyroidism and multi nodular thyroid. Pathologic findings were consistent with hyperplasia and demonstrated a fifth parathyroid gland in the thyroid. Two years later, the patient presented recurrent hyperparathyroidism associated with terminal renal insufficiency, fusion of Sesta Mibi scintigraphy and CT scan demonstrated a sixth mediastinal parathyroid gland in the aorto pulmonary window. Despite videomediastinoscopic attempts, resection was performed through manubriotomy approach. Pathologic findings demonstrated a parathyroid adenoma.