Q: What is the diagnosis?
Bilateral 4-gland exploration revealed a right superior parathyroid
adenoma at the lower paratracheal area. (Fig.2). Histology confirmed the
presence of an encapsulated, 10gr/4.5X2.3 cm, parathyroid adenoma. A
peripheral rim of normal glandular tissue was identified.
Primary hyperparathyroidism is the most common cause of hypercalcemia in
the adult population. The diagnosis is biochemical and entails an
inappropriately high PTH level despite high-normal/high
Ca++ serum level. Secondary causes of PTH elevation
should be ruled out. Imaging studies does not aid in the diagnosis and
are not used for selecting patients for surgical referral [1]. Even
though various minimally invasive techniques do exist, open bilateral
4-gland exploration is the preferred operative strategy in cases with
discordant or negative preoperative localization studies [1,2].