Affiliation:
1. Sidney Kimmel Medical College Thomas Jefferson University Philadelphia Pennsylvania USA
2. Department of Otolaryngology—Head and Neck Surgery Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
Abstract
AbstractAberrant migration of parathyroid glands from their embryologic origin may result in undescended parathyroid glands. We present a case of an ectopic parathyroid adenoma at the level of the pyriform sinus. A 41‐year‐old female was evaluated for primary hyperparathyroidism. Following non‐localizing ultrasound and planar sestamibi imaging, the patient underwent SPECT/CT and 4‐D computed tomography demonstrating evidence of an ectopic parathyroid adenoma. The surgical approach was modified based on the location. Following extirpation, PTH fell from 80 to 16 pg/mL, and the 15‐min post‐excision level remained stable at 14pg/mL, indicating a biochemical cure. While rare, undescended parathyroid adenoma should be considered when preoperative imaging fails to identify a target adenoma or after unsuccessful surgery. The combined use of 99m Tc‐MBI or 4D CT and other anatomical scans may improve diagnostic accuracy. Due to the potential need to perform a second incision to conduct a four‐gland exploration, preoperative patient discussion regarding surgical risks may differ from that of a standard parathyroidectomy.