Atypical anatomical location of parathyroid adenoma

Primary hyperparathyroidism (PHPT) is an endocrine disease that develops due to excessive production of parathyroid hormone (PTH) by the parathyroid glands (PTG). The only radical treatment for PHPT is surgical removal of the affected gland —parathyroidectomy. The success of the operation directly depends on accurate preoperative diagnosis and determination of the pathological gland’s location, which is the main difficulty. The parathyroid glands are typically found on the thyroid gland’s posterior surface; however, the anatomy of this area is very variable, and the glands can be found in the most unexpected places. A person can have between two and eight parathyroid glands, making the search much more difficult. The pathological gland can be either significantly enlarged or remain within normal sizes, which makes it indistinguishable from healthy glands at visual examination. All these factors make diagnosis difficult and increase the risk of unsuccessful surgery. If the affected gland cannot be detected and removed during surgery, the patient faces persistence of the disease with the preservation of all symptoms and health risks. The diagnostic method is choosen individually by an endocrinologist. It is important to remember that timely diagnosis and proper treatment of PHPT play a decisive role in the prognosis of the disease. This article describes a clinical case demonstrating a variant of the atypical anatomical location of the parathyroid adenoma in zone X, the peculiarity of which emphasizes the importance of imaging methods at the preoperative stage.

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