ECTOPIC PARATHYROID: POSSIBLE CLINICAL AND BIOCHEMICAL PREDICTORS

AUTHORS:
P. Laguna-Hernandez (Alcalá de Henares, Spain) , F. Mañes-Jimenez (Alcalá de Henares, Spain) , D. Cordova-Garcia (Alcalá de Henares, Spain) , M. Bru-Aparicio (Alcalá de Henares, Spain) , R. Diaz-Pedrero (Alcalá de Henares, Spain) , R. Alvarado-Hurtado (Alcalá de Henares, Spain) , R. San Roman-Romanillos (Alcalá de Henares, Spain) , Y. Allaoua-Moussaoui (Alcalá de Henares, Spain) , S. Sanchez de Toca-Gomez (Alcalá de Henares, Spain) , P. Urbon-Sanchez (Alcalá de Henares, Spain) , S. Soto-Schutte (Alcalá de Henares, Spain) , L. Jimenez-Alvarez (Alcalá de Henares, Spain) , R. Jimenez-Martin (Alcalá de Henares, Spain) , E. Ovejero-Merino (Alcalá de Henares, Spain) , T. Ratia-Gimenez (Alcalá de Henares, Spain) , A. Gutierrez-Calvo (Alcalá de Henares, Spain)
Background:
Primary hyperparathyroidism (PHP) is the most frequent cause of hypercalcemia, and the only curative treatment is surgery. Around 6-22% are ectopic parathyroid adenomas, and it can be a cause of hypercalcemia persistence and recurrence. The main locations of ectopic adenomas are: thymus, mediastinum, paraesophageal, thyroid
Methods:
Retrospective, observational study of parathyroid operated in our hospital since 2020-November 2023. Variants studied: epidemiologycal, biochemical test, follow-up…
Results:
Since 2020, we operated 87 patients with PHP. Of those 87 patients, 12 were ectopic adenoma (13%). Women were 10 patientes of 12 (83,3%). The location more frequent was paraesophageal (4 patients, 33,3%) and inside thyroid (4 patients, 33,3%). Other locations were: 2 Tracheoesophageal sulcus, 1 carotid, 1 Thyrothymic ligament. The medium serum calcium preoperative was 11'13mg/dl and 9'3mg/dl posoperative. All patients had lower intraoperative iPTH compared to baseline and intraoperative anatomopathological results were in line to parathiroid adenoma. The medium preoperative iPTH was 131pg/ml and 42 posoperative. Half of ectopic adenomas were located by imagen test (PET, CT-scan); the others were intraoperative findings. In the immediate postoperative period 2 patients had transient hipocalcemia, solved with oral calcium. Other 2 patients, had persistent hypercalcemia although pathology and biochemical results after the surgery were concordant; in addition, in less than 1month had elevated iPTH levels again
Conclusions:
According to literature, could exist some possible clinical and biochemical predictors such as serum calcio preoperative, high iPTH levels for can suspect a possible ectopic parathyroid non visible in imaging test. We need more studys to comfirm this