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Hiperparatiroidismo ectópico: Detección de la localización mediastinal / Ectopic hyperparathyroidism. Detection of mediastinal localization
Boccalatte, Luis A; Gómez, Natalia L; Olivera López, Soledad; Yanzon, Alejandro; Abuawad, Carla Y; F, Figari.
  • Boccalatte, Luis A; Hospital Italiano de Buenos Aires. Servicio de Cirugía General. Cirugía de cabeza y cuello. AR
  • Gómez, Natalia L; Hospital Italiano de Buenos Aires. Servicio de Cirugía General. Cirugía de cabeza y cuello. AR
  • Olivera López, Soledad; Hospital Italiano de Buenos Aires. Servicio de Cirugía General. AR
  • Yanzon, Alejandro; Hospital Italiano de Buenos Aires. Servicio de Cirugía General. Cirugía de cabeza y cuello. AR
  • Abuawad, Carla Y; Hospital Italiano de Buenos Aires. Servicio de Cirugía General. Cirugía de cabeza y cuello. AR
  • F, Figari; s.af
Medicina (B.Aires) ; 80(1): 39-47, feb. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1125036
RESUMEN
El tejido paratiroideo ectópico es una causa frecuente de recurrencia del hiperparatiroidismo (HPT) siendo de 16% en primarios y 14% en secundarios. La localización intratorácica representa el 20-35%, pero solo un 2% requiere una cirugía torácica. El objetivo fue analizar una cohorte de pacientes con diagnóstico de HPT mediastinal operados en un hospital de alta complejidad de Argentina. Se realizó un estudio retrospectivo de todos los operados por HPT entre enero de 2006 y julio 2019 en ese hospital. Se incluyeron aquellos que requirieron acceso torácico por HPT ectópico. En este período se trataron 728 pacientes con HPT primario y secundario. Seis con primario y 3 con secundario requirieron cirugía torácica. Se realizaron 6 videotoracoscopias (VATS) y 3 esternotomías, sin complicaciones graves. Se utilizó biopsia por congelación en todos y dosaje de paratohormona intraoperatoria (PTHi) en 8 casos, que descendió en promedio 65% respecto al valor basal. Se confirmaron 5 adenomas y 4 hiperplasias. La enfermedad paratiroi dea mediastinal representó el 1.65% (12/728), mientras que recibieron tratamiento quirúrgico en nuestra institución 1.24% (9/728). La biopsia por congelación y el descenso de PTHi resultan útiles para confirmar el foco y eventualmente disminuir el riesgo de recurrencia. La VATS es segura pero depende del entrenamiento y de la disponibilidad en el medio asistencial. Si bien el sestamibi es el método con mayor sensibilidad, se propone el uso de 18F-colina PET/TC ante la sospecha de HPT ectópico. La posibilidad de obtener conclusiones basadas en la evidencia requiere de estudios con mayor número de pacientes.
ABSTRACT
The ectopic parathyroid tissue is a frequent cause of recurrent hyperparathyroidism (HPT), accounting 16% in primary HPT and 14% in secondary cases. Although intrathoracic ectopic glands represent 25-35% of all ectopic cases, only 2% requires thoracic surgery. The aim of this study is to report a case series of patients with ectopic mediastinal HPT treated by thoracic approach in a private institution in Argentina. This is a retrospective analysis from January 2006 to June 2019. All patients diagnosed with ectopic hyperparathyroidism who required a thoracic surgical approach were included. During this period, 728 patients with primary HPT and secondary HPT were treated. Six with primary HPT and 3 with secondary HPT required a thoracic approach. Six video-assisted thoracoscopy surgeries (VATS) and 3 sternotomies were performed. None of them presented serious posoperative complications. Frozen section biopsy was used in all cases. iPTH was measured in 8 cases, with a mean drop of 65% after 15 minutes. Final pathology reports confirmed 5 adenomas and 4 hyperplasias. Our case series reported an incidence of 1.65% (12/728) mediastinal parathyroids, while 1.24% (9/728) received surgical treatment at our institution. Intraoperative frozen section and PTHi are useful to confirm the diagnosis and to avoid recurrences. Although VATS is a safe and efficient treatment option, it depends on surgical training and availability. In terms of diagnostic imaging resources, sestamibi remains the current gold standard. However, 18F-choline PET/CT may arise as a new diagnostic tool. The possibility of obtaining evidence-based conclusions requires studies with higher number of patients.
Subject(s)

Full text: Available Index: LILACS (Americas) Main subject: Parathyroid Glands / Hyperparathyroidism Type of study: Diagnostic study / Observational study / Risk factors Limits: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male Country/Region as subject: South America / Argentina Language: Spanish Journal: Medicina (B.Aires) Journal subject: Medicine Year: 2020 Type: Article Affiliation country: Argentina Institution/Affiliation country: Hospital Italiano de Buenos Aires/AR

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Full text: Available Index: LILACS (Americas) Main subject: Parathyroid Glands / Hyperparathyroidism Type of study: Diagnostic study / Observational study / Risk factors Limits: Adolescent / Adult / Aged / Aged80 / Female / Humans / Male Country/Region as subject: South America / Argentina Language: Spanish Journal: Medicina (B.Aires) Journal subject: Medicine Year: 2020 Type: Article Affiliation country: Argentina Institution/Affiliation country: Hospital Italiano de Buenos Aires/AR