Tay Yen Zhir, Balasubbiah Narendran, Awang Raflis Ruzairee, Retna Pandian Benedict Dharmaraj, Sathiamurthy Narasimman
General Surgery, Thoracic Surgery Unit, Kuala Lumpur Hospital, Kuala Lumpur, MYS.
General Surgery, Breast and Endocrine Surgery Unit, Kuala Lumpur Hospital, Kuala Lumpur, MYS.
Cureus. 2024 Mar 23;16(3):e56792. doi: 10.7759/cureus.56792. eCollection 2024 Mar.
Primary hyperparathyroidism (PHPT) usually presents with symptoms of hypercalcemia which is due to excessive secretion of parathyroid hormone (PTH). Surgical removal of the secreting tumor either adenoma or hyperplasia remains the mainstay of treatment. Around 2% to 25% of the lesions are located in the mediastinum. We reviewed our institution's surgical treatment and approach to mediastinal parathyroid adenoma (MPA). We retrospectively reviewed the demography, comorbidities, clinical presentation, surgical approach, and outcome for patients in our institution who underwent surgery for MPA from September 2019 until August 2023. All patients with MPA who underwent surgery were included in the review. The surgical approaches used were both video-assisted thoracoscopic surgery (VATS) and median sternotomy. There were three patients with PHPT due to MPA who underwent surgery. Out of the three patients, two were female. The mean age was 48.6 years old, ranging from 16 to 66 years old. All of them presented with PHPT with a raised mean serum calcium level of 3.52 mmol/L (range: 2.84-4.38 mmol/L) and a mean PTH or intact PTH (iPTH) level of 274.6 pmol/L (range: 8.87-695 pmol/L). Ultrasound of the neck was performed for all the patients before further investigations were done to look for the ectopic parathyroid gland. Computed tomography (CT) of the thorax showed mediastinal parathyroid mass in all the patients with an average size of 2.4 x 2.1 x 2.3cm (range: 1.3-3.8cm), which showed uptake in 99mTc-hexakis-2-methoxyisobuthylisonitrile (Tc99m-MIBI) scintigraphy. VATS was performed for two cases and an upper partial sternotomy was performed for one patient. Postoperatively, iPTH and serum calcium levels were reduced significantly for all patients. There were no post-operative complications in our study. Comprehensive diagnostic imaging and surgical planning are important for the localization of MPA. In our review, all cases were promptly diagnosed and underwent surgery without complication.
原发性甲状旁腺功能亢进症（PHPT）通常表现为高钙血症症状，这是由于甲状旁腺激素（PTH）分泌过多所致。手术切除分泌肿瘤，即腺瘤或增生，仍然是主要的治疗方法。约2%至25%的病变位于纵隔。我们回顾了我们机构对纵隔甲状旁腺腺瘤（MPA）的手术治疗及方法。我们回顾性分析了2019年9月至2023年8月在我们机构接受MPA手术的患者的人口统计学、合并症、临床表现、手术方法及结果。所有接受MPA手术的患者均纳入本回顾研究。所采用的手术方法包括电视辅助胸腔镜手术（VATS）和正中胸骨切开术。有3例因MPA导致的PHPT患者接受了手术。在这3例患者中，2例为女性。平均年龄为48.6岁，年龄范围为16至66岁。他们均表现为PHPT，平均血清钙水平升高至3.52 mmol/L（范围：2.84 - 4.38 mmol/L），平均甲状旁腺激素或完整甲状旁腺激素（iPTH）水平为274.6 pmol/L（范围：8.87 - 695 pmol/L）。在进行进一步检查以寻找异位甲状旁腺之前，对所有患者均进行了颈部超声检查。胸部计算机断层扫描（CT）显示所有患者均有纵隔甲状旁腺肿块，平均大小为2.4 x 2.1 x 2.3cm（范围：1.3 - 3.8cm），在99m锝-六甲基丙烯胺肟（Tc99m - MIBI）闪烁扫描中显示有摄取。2例患者接受了VATS手术，1例患者接受了上半部分胸骨切开术。术后，所有患者的iPTH和血清钙水平均显著降低。我们的研究中未出现术后并发症。综合诊断性影像学检查和手术规划对于MPA的定位很重要。在我们的回顾研究中，所有病例均得到及时诊断并接受手术，且无并发症发生。
