Intrathymic ectopic parathyroid adenoma caused primary hyperparathyroidism with vitamin D deficiency several years after bariatric surgery

Undescended retropharyngeal parathyroid adenoma with adjacent thymic tissue in a 13-year-old boy with primary hyperparathyroidism

We describe a rare presentation of a symptomatic parathyroid adenoma located in an ectopic retropharyngeal position in a 13-year-old boy. Preoperative CT scan and MRI demonstrated the ectopic location of the parathyroid adenoma. The patient underwent successful parathyroidectomy with cure of his hyperparathyroidism. On pathologic exam, the specimen was made up of a parathyroid adenoma and adjacent thymic tissue, indicating that it was likely an undescended lower parathyroid gland arising from the third pharyngeal pouch. Ectopic retropharyngeal parathyroid adenomas are very rare and to our knowledge, none have been previously described in adolescents.

Thoracoscopic approach in the treatment of ectopic thymic parathyroid adenoma

Primary hyperparathyroidism is overproduction of parathyroid hormone, causing hypercalcemia. Parathyroid adenomas have been found to be the etiology for 80% of cases of primary hyperparathyroidism, while almost a quarter of them are ectopic. We present a case of ectopic thymic parathyroid adenoma, treated by the thoracoscopic approach. Preoperative computed tomogram and technetium-99-sestamibi imaging showed an adenoma, located in the front mid-mediastinum, approximately 8 × 10 mm in size. Resection of the tumor was indicated according to the persistent hypercalcemia after unsuccessful surgical treatment performed 3 years ago. It was decided to perform a parathyroidectomy during thoracoscopy. The diagnosis of parathyroid adenoma was established on postoperative histopathology staining. The patient was discharged from hospital 5 days after the surgery. We found this minimally invasive operation to be an effective and well-tolerated treatment option, determined by the experience of the surgeon.