ECEESPE2025 ePoster Presentations Environmental Endocrinology (23 abstracts)
Primary hyperparathyroidism due to ectopic parathyroid lesions: our experience
Jaweher Kechiche 1 , Abir Meherzi 1 , Taieb Ach 2 , Habiba Ben Sghaier 1 , Jihen Houas 1 , Ghada Saad 2 , Malika El Omri 1 , Monia Ghammem 1 , Mouna Bellakhdher 1 , Yosra Hasni El Abed 2 , Wassin Kermani 1 & Mohamed Abdelkefi 1
1Farhat Hached University Hospital, ENT Head and Neck Surgery, Sousse, Tunisia; 2Farhat Hached University Hospital, Endocrinology Departement, Sousse, Tunisia
JOINT3782
Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disorder with a prevalence of 1to 7cases per 1000 adults. In PHPT, the incidence of ectopic parathyroid glands ranges from 10% to 20%. Ectopic parathyroid adenomas arise due to abnormal migration of the parathyroid glands during embryonic development. Although ectopic parathyroid adenomas are relatively rare, they pose a significant diagnostic and surgical challenge. The atypical location of these adenomas can lead to delayed diagnosis and persistent or recurrent hyperparathyroidism following unsuccessful surgery. Standard imaging techniques such as ultrasound, SPECT-CT with 99mTc-sestamibi, and MRI. The aim of this study was to assess clinicopathological features and the effectiveness of radiological tools in localizing ectopic parathyroid adenomas in patients with primary hyperparathyroidism.
Materials and methods: This is a retrospective study conducted from January 2010 to December 2023, including all patients underwent surgery for PHPT. PHPT with ectopic parathyroid adenoma were included in this study.
Results: During the study period, 80 patients underwent surgery for primary hyperparathyroidism. Among them, 10 patients (12,5%) were diagnosed with ectopic parathyroid adenomas. The mean age of patients with ectopic adenomas was 59 years (range: 42–72 years), with a male-to-female ratio of 1:4. The most common clinical symptoms included fatigue (75%), bone pain (50%), nephrolithiasis (41%). Preoperative serum calcium levels ranged from 2.95 to 3.85 mmol/l, with a mean level of 3.42 mmol/l. PTH levels were significantly elevated, with amean value of 423 ng/l (range: 180–1200 ng/l). All patients underwent ultrasound and SPECT with 99mTc-sestamibi for preoperative localization. SPECT-CT was performed in 6 cases. SPECT-CT successfully identified ectopic adenomas in 5 cases (90%). Ultrasound detected ectopic adenomas in 7 cases (70%). MRI was performed in 2 cases and successfully localized the adenoma in all. The most common ectopic locations included: Mediastinum (2 cases, 20%), Intrathyroidal (2 cases, 20%), Retroesophageal space (1 cases, 10%) Carotid bifurcation (1 case, 10%), submandibular (1 case, 10%), thymus (3 cases,30 %). After surgery, serum calcium and PTH levels normalized in 9 patients. However, 1 case of persistent hyperparathyroidism was reported due to an intrathyroidal parathyroid adenoma, which required further surgical intervention.
Conclusions: Ectopic parathyroid adenomas are a significant cause of persistent or recurrent primary hyperparathyroidism, posing both diagnostic and surgical challenges. Preoperative localization using SPECT-CT with 99mTc-sestamibi, ultrasound, and MRI plays a crucial role in identifying ectopic lesions, particularly in atypical locations.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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