Reoperative Parathyroid Surgery: Role of the Overly-Descended Superior Adenoma in Persistent Disease

Abstract

Objectives:

(1) Recognize that failure to identify an ectopic, overly-descended superior parathyroid adenoma may contribute to failed parathyroid exploration. (2) Understand the prevalence of an ectopic, overly-descended superior parathyroid adenoma in both primary and reoperative parathyroid surgery in patients with single-gland primary hyperparathyroidism. (3) Describe the findings that should lead the clinician to suspect the presence of an ectopic, overly-descended superior adenoma.

Methods:

A retrospective review of patients undergoing curative surgery for single-gland parathyroid adenomas at a single institution was performed. Clinical records, imaging studies, operative reports, and pathology findings were evaluated, and all instances of an ectopic, overly-descended superior parathyroid adenoma were identified. The prevalence of this entity in both primary and revision surgeries was calculated.

Results:

There were 270 cases of curative surgery for single-gland parathyroid adenomas during the study period. There were 251 primary operations and 19 re-operative procedures referred from outside institutions. An ectopic, overly-descended superior parathyroid adenoma was present in 9.2% of primary cases and in 21.1% of reoperative cases. While this condition was more common in the reoperative setting (as expected) the incidence in the primary setting was higher than anticipated, and in fact the difference did not reach statistical significance (P = .1).

Conclusions:

An overly-descended superior parathyroid adenoma is common in both the reoperative and primary settings. Recognition and proper treatment of this entity at the initial operation will reduce the need for revision surgery.