VATS for Resection of Mediastinal Parathyroids

Study Overview
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Brief Summary
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Background: hyperparathyroidism (HPT) is a disease caused by hypersecretion of one or more parathyroid glands, it can be associated with ectopic mediastinal parathyroid glands (MEPA) in 2% of cases. The use of video-assisted thoracoscopic surgery (VATS) for the surgical resection of these glands is a safe, cost-effective, and low-morbidity option for patients with MEPA. We report a case series of patients with this disease managed with VATS. Patients & Methods: From 2008 to 2022, a retrospective study involving patients with MEPA and treated by VATS approach was performed in a tertiary hospital in Mexico City. Relevant biochemical and clinical variables such as imaging studies, pre and postoperative lab results, surgical strategy and outcomes, and pathological analyses were analyzed.

Detailed Description
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Hyperparathyroidism (HPT) is a clinical disorder characterized by an inappropriately elevated paratohormone (PTH) due to hypersecretion of one or more parathyroid glands, that may develop secondary hypercalcemia and other metabolic disturbances. This disease includes various signs and symptoms such as nephrolithiasis, osteopenia and osteoporosis, depression, mental numbness, loss of appetite, nausea, vomiting, constipation among others. The abnormal secretion of PTH is most commonly caused by a single parathyroid gland adenoma in 85% of the cases, in the other 15% is due to multiple gland hyperplasia (15-20%)(1) or rarely from a parathyroid carcinoma (<1%). HPT occurs in both genders equally around the sixth decade(2). World HPT prevalence is estimated at 1 in every 500 women and 1 in every 2000 men(3). Mediastinal ectopic parathyroid adenomas (MEPA) are rare tumors, constituting 1-2% of all parathyroid adenomas. These glands are inferior to the sternal notch and their location may vary from the superior mediastinum to the pericardium and diaphragm(4). The first report of a mediastinal parathyroid adenoma was in 1932 by Churchill in the patient Captain Charles E. Martell, who had 6 prior cervical explorations for his hyperparathyroidism until an ectopic gland was found in the superior mediastinum(5). Before the introduction of VATS, MEPA were usually resected by thoracotomy or a median sternotomy, currently with the daily use of minimally invasive surgery, VATS is being adopted as the procedure of choice. The aim of this study to report a case series of patients with MEPA treated with VATS, along with a literature review.

Official Title
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Thoracoscopic Treatment of Mediastinal Ectopic Parathyroid Adenomas: A Case Series and Literature Review

Conditions
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Mediastinal Parathyroid Adenoma, Hyperparathyroidism

Intervention / Treatment
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* Procedure: VATS resection of MEPA


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with MEPA Exclusion Criteria: incomplete records

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: VATS resection of MEPA|VATS resection of mediastinal parathyroid adenoma|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Biochemical cure of hyperparathyroidism | Normalization of Paratohormone leves | 24hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hyperparathyroidism, Video-assisted thoracoscopy surgery, Mediastinal ectopic parathyroid adenoma