RECURRENT RENAL HYPERPARATHYROIDISM CAUSED BY AN ECTOPIC MEDIASTINAL GLAND huishyuan@gmail.com

PE098

RECURRENT RENAL HYPERPARATHYROIDISM CAUSED BY AN ECTOPIC MEDIASTINAL GLAND

2

Singapore

Poster Exhibition only

Recurrent hyperparathyroidism after exploration is a challenging condition particularly due to patient’s medical comorbidities. We report a case of a 67-year-old lady with recurrent renal hyperparathyroidism after 3 re-exploration surgeries.

Mdm P, a 67 year old lady underwent bilateral neck exploration in 2009, at which time the right inferior gland could not be located. The left inferior parathyroid was reimplanted into left deltoid. Histology was consistent with parathyroid tissue, and she had a drop in parathyroid hormone (PTH) after. However, her PTH rose again within 6 months, and she had a repeat neck exploration and left hemithyroidectomy in 2011 with removal of a left sided parathyroid gland confirmed on histology.

As her PTH levels rose again within two years, she underwent a third surgery with removal of a further parathyroid gland in the neck as well as the deltpoid implants. Despite this, her PTH did not adequate fall and hence she was offered a repeat localisation. A sestamibi scan and 4 dimensional CT scan of the neck was done which showed both hyperplastic parathyroid tissue in left deltoid as well as uptake in a nodule in the superior mediastinum. Options including video assisted thoracoscopic surgery and radiology guided ablation were offered but patient declined further aggressive treatment at this time.

This case illustrates how ectopic parathyroid tissue in an unexpected location can lead to persistent hyperparathyroidism in the setting of end stage renal failure.