VATS for Resection of Mediastinal Parathyroids

Hyperparathyroidism Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05696405
• Other study ID #: 004
• Status: Completed
• Start date: January 1, 2008
• Est. completion date: January 1, 2022

Study information

• Verified date: January 2023
• Source: Hospital General Ajusco Medio
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 4
• Est. completion date: January 1, 2022
• Est. primary completion date: January 1, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Patients with MEPA

Exclusion Criteria:

• incomplete records

Related Conditions & MeSH terms

• Adenoma
• Hyperparathyroidism
• Parathyroid Neoplasms

Intervention

Procedure:
• VATS resection of MEPA
VATS resection of mediastinal parathyroid adenoma

Locations

Country	Name	City	State
n/a

Sponsors (2)

Lead Sponsor	Collaborator
Hospital General Ajusco Medio	Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran

References & Publications (7)

Hu J, Ngiam KY, Parameswaran R. Mediastinal parathyroid adenomas and their surgical implications. Ann R Coll Surg Engl. 2015 May;97(4):259-61. doi: 10.1308/003588415X14181254789088. — View Citation

Kitada M, Yasuda S, Nana T, Ishibashi K, Hayashi S, Okazaki S. Surgical treatment for mediastinal parathyroid adenoma causing primary hyperparathyroidism. J Cardiothorac Surg. 2016 Apr 7;11:44. doi: 10.1186/s13019-016-0461-8. — View Citation

Long KL, Lee CY, Ramaiah C, Sloan DA. Intrapericardial parathyroid adenomadagger. J Surg Case Rep. 2013 Aug 29;2013(8):rjt064. doi: 10.1093/jscr/rjt064. — View Citation

Medrano C, Hazelrigg SR, Landreneau RJ, Boley TM, Shawgo T, Grasch A. Thoracoscopic resection of ectopic parathyroid glands. Ann Thorac Surg. 2000 Jan;69(1):221-3. doi: 10.1016/s0003-4975(99)01127-3. — View Citation

Spence HM. The life and death of Captain Charles Martell and kidney stone disease. J Urol. 1984 Dec;132(6):1204-7. doi: 10.1016/s0022-5347(17)50098-1. — View Citation

Sreevathsa MR, Melanta K. Unilateral Exploration for Parathyroid Adenoma. Indian J Surg Oncol. 2017 Jun;8(2):142-145. doi: 10.1007/s13193-016-0605-2. Epub 2016 Dec 27. — View Citation

Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, Doherty GM, Herrera MF, Pasieka JL, Perrier ND, Silverberg SJ, Solorzano CC, Sturgeon C, Tublin ME, Udelsman R, Carty SE. The American Association of Endocrine Surgeons Guidelines for Definitive Manage — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Biochemical cure of hyperparathyroidism	Normalization of Paratohormone leves	24hours