Mediastinal ectopic parathyroid adenomas: diagnostic and therapeutic challenge

Introduction: Mediastinal parathyroid adenomas are a rare condition. Aim: Analysis of epidemiological data, clinical manifestation of mediastinal parathyroid adenoma (MPA), including imaging modalities, and therapeutic approach to this condition. Material and methods: A retrospective study of documented cases of mediastinal parathyroid adenoma that were managed at our Department of Thoracic Surgery of the Military Teaching Hospital Mohammed V, between January 2010 and December 2019. Results: During a 9-year period in our department, 21 documented cases of MPA were treated surgically. Patients ranged in age from 20 to 69 years, with a mean age of 45 years, and there was no gender predominance. The most frequently reported manifestations were osteoarticular, with bone pain in 66.6% (14/21), pathological fractures in 28.5% (6/21), and osteoporosis in 23.8% (5/21). Cervical ultrasound, MIBI scintigraphy and cervico-thoracic computed tomography scan were performed respectively in 28.5% (n = 06/21), in 47.6% (n = 10/21) and 100% (n = 21), and allowed positive diagnosis of MPA. All patients benefited from resection surgery, through a classical transverse cervicotomy which was extended in some cases to the manubrium, and in only one case treated with thoracotomy. Conclusions: Management of mediastinal parathyroid adenoma is based on the diagnosis imaging assessment step, usually by MIBI scintigraphy. Surgical ablation is a radical treatment. Peroperative hormonal evaluation is mainly recommended.