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Primary hyperparathyroidism caused by a tiny mediastinal parathyroid adenoma with non-localising imaging studies
  1. Pedro Polastri Lima Peixoto1,
  2. Daniella de Freitas Pereira Calheiros Ângelo Durço2 and
  3. Luiz Carlos Conti de Freitas1
  1. 1 Department of Ophtalmology, Otolaryngology, Head and Neck Surgery, University of Sao Paulo Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil
  2. 2 Department of Pathology and Forensic Medicine, University of Sao Paulo Clinics Hospital of the Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, Brazil
  1. Correspondence to Dr Pedro Polastri Lima Peixoto; pplpeixoto{at}


Variations in parathyroid gland positions often cause failure in initial parathyroid adenoma surgery, especially when imaging fails to localise the adenoma. This report describes a female patient with primary hyperparathyroidism for which preoperative localisation studies did not determine the position of the hyperfunctioning gland. The initial approach with bilateral cervical exploration and intraoperative parathyroid hormone monitoring was performed unsuccessfully. A mediastinal adenoma was suspected due to meticulous negative neck exploration and repeated negative images for a neck adenoma. Subsequently, a second approach involving mediastinal exploration was performed. After the removal of remnant thymic tissue in the mediastinal space, a significant drop in intraoperative parathyroid hormone levels was achieved. The pathological result confirmed the presence of a tiny pathological parathyroid adenoma within the thymus. At 6 months follow-up, postoperative biochemical assessment was consistent with normal calcium and parathyroid hormone levels.

  • head and neck surgery
  • anatomic variation
  • endocrinology
  • metabolic disorders
  • cardiothoracic surgery

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: PP and LCCdF. The following authors gave final approval of the manuscript: PP and LCCdF.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.