Murat AKAL, Murat ÖZKAN, Elgin ÖZKAN, Mehmet Ali SAKALLI

Excision of mediastinal parathyroid adenoma under theguidance of gamma probe

Paratiroid adenomları primer hiperparatiroidizmin en sık nedenidir. Bu yazıda yorgunluk, hiperkalsemi ve hiperparatiroidisi olan 44 yaşında bir erkek hasta sunuldu. Paratiroid sintigrafisi ve torasik bilgisayarlı tomografisinde, ektopik olarak ön mediastende yerleşim gösteren paratiroid adenomu ile uyumlu bir lezyon görüldü. Paratiroid adenomu ameliyat sırası gama prob kılavuzluğunda başarı ile eksize edildi. Paratiroid adenomlarının yerleşiminin ameliyat öncesinde belirlenmesi gereklidir. Bu nedenle; ultrasonografi, paratiroid sintigrafisi ve paratiroid sintigrafisi pozitif olan hastalarda ameliyat sırasında yapılan gama prob kılavuzluğu tanı ve cerrahi tedavinin başarısı için çok önemlidir

Gama prob kılavuzluğunda mediastinal paratiroid adenomunun eksizyonu

Parathyroid adenomas are the most frequent cause of primary hyperparathyroidism. In this article, we report a 44-year-old male patient with fatigue, hypercalcemia and hyperparathyroidism. Parathyroid scintigraphy and thoracic computed tomography revealed a lesion consistent with parathyroid adenoma ectopically located in the anterior mediastinum. The parathyroid adenoma was excised successfully under the guidance of intraoperative gamma probe. It is essential to determine the localization of parathyroid adenomas preoperatively. Therefore; ultrasonography, parathyroid scintigraphy and guidance of intraoperative gamma probe in patients with positive parathyroid scintigraphy are crucial for diagnosis and success of surgical treatment.

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Elgazzar A. Parathyroid gland. In: Elgazzar A, editor. The pathophysiologic basis of nuclear medicine. Chapter 7. Berlin: Springer; 2001. p. 141-6.
Mariani G, Gulec SA, Rubello D, Boni G, Puccini M, Pelizzo MR, et al. Preoperative localization and radioguided parathyroid surgery. J Nucl Med 2003;44:1443-58.
Harris L, Yoo J, Driedger A, Fung K, Franklin J, Gray D, et al. Accuracy of technetium-99m SPECT-CT hybrid images in predicting the precise intraoperative anatomical location of parathyroid adenomas. Head Neck 2008;30:509-17.
Rubello D, Casara D, Shapiro B. Recent advances in preoperative and intraoperative nuclear medicine procedures in patients with primary hyperparathyroidism. Panminerva Med 2002;44:99-105.
Ugur O, Kara PO, Bozkurt MF, Hamaloglu E, Tezel GG, Salanci BV, et al. In vivo characterisation of parathyroid lesions by use of gamma probe: comparison with ex vivo count method and frozen section results. Otolaryngol Head Neck Surg 2006;134:316-20.
Quillo AR, Bumpous JM, Goldstein RE, Fleming MM, Flynn MB. Minimally invasive parathyroid surgery, the Norman 20% rule: is it valid? Am Surg 2011;77:484-7.
Gil-Cárdenas A, Gamino R, Reza A, Pantoja JP, Herrera MF. Is intraoperative parathyroid hormone assay mandatory for the success of targeted parathyroidectomy? J Am Coll Surg 2007;204:286-90.
Onoda N, Ishikawa T, Nishiyama N, Kawabe J, Takashima T, Hirakawa K. Focused approach to ectopic mediastinal parathyroid surgery assisted by radio-guided navigation. Surg Today 2014;44:533-9.