Open Access Case report

Is minimally invasive parathyroid surgery an option for patients with gestational primary hyperparathyroidism?

Cino Bendinelli12*, Shane Nebauer2, Tuan Quach3, Shaun Mcgrath3 and Shamasunder Acharya3

Author Affiliations

1 Department of Surgery, John Hunter Hospital, New Lambton Heights, NSW, Australia

2 University of Newcastle, Callaghan, NSW, Australia

3 Department of Endocrinology, John Hunter Hospital, New Lambton Heights, NSW, Australia

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BMC Pregnancy and Childbirth 2013, 13:130  doi:10.1186/1471-2393-13-130

Published: 11 June 2013

Abstract

Background

Gestational primary hyperparathyroidism is associated with serious maternal and neonatal complications, which require prompt surgical treatment. Minimally invasive parathyroidectomy reduces pain, improves cosmesis and may achieve cure rates comparable to traditional open bilateral neck exploration. We report the clinical course of a woman with newly diagnosed gestational primary hyperparathyroidism and discuss the decision making behind the choice of video-assisted minimally invasive parathyroidectomy, amongst the other minimally invasive parathyroidectomy techniques available.

Case presentation

A 38-years-old pregnant woman at 9 weeks of gestation, with severe hyperemesis and hypercalcaemia secondary to gestational primary hyperparathyroidism (ionised calcium 1.28 mmol/l) was referred for surgery. Ultrasound examination of her neck identified 2 suspicious parathyroid enlargements. In view of pregnancy, a radioisotope Sestamibi parathyroid scan was not performed. Bilateral four-gland exploration was therefore deemed necessary to guarantee cure. This was performed with video-assisted minimally invasive parathyroidectomy, which relies on a single 15 mm central incision with external retraction and endoscopic magnification, allowing bilateral neck exploration.

Surgery was performed at 23 weeks of gestation. Four glands were identified in orthotopic positions of which three had normal appearance. The fourth was a right superior parathyroid adenoma of 756 mg. Ionized calcium (1.12 mmol/l) and PTH (0.9 pmol/l) normalised postoperatively. Patient was discharged on the second postoperative day, needing no pain relief. Cosmetic result was excellent. Her pregnancy progressed normally and she delivered a healthy baby.

Conclusion

Video-assisted minimally invasive parathyroidectomy allows bilateral four-gland exploration, and is an optimal technique to treat gestational primary hyperparathyroidism. This procedure removes the need for radiation exposure, reduces pain, improves cosmesis and may achieve cure rates comparable to traditional open bilateral neck exploration.

Keywords:
Minimally invasive; Parathyroidectomy; Gestational primary hyperparathyroidism; Video assisted; Hypercalcemia without Sestamibi