Adedenomas ectópicos de paratiroides: sensibilidad y valor de las pruebas diagnósticas para el tratamiento quirúrgico

espanolOBJETIVOS. Presentar las peculiaridades clinico-quirurgicas de los adenomas ectopicos de paratiroides relacionandolas con las de los adenomas normotopicos. Determinar el valor de las pruebas diagnosticas para asegurar el exito terapeutico. MATERIAL Y METODOS. Estudio prospectivo de 158 pacientes intervenidos por hiperparatiroidismo primario (1998-2010). 83% mujeres. Edad media 62,8 anos�}13,7. Para el diagnostico topografico se usaron la gammagrafia con Tecnecio-sestaMIBI, ECO y TAC (ocasional) y para asegurar la exeresis quirurgica, la monitorizacion intraoperatoria de PTH y, eventualmente en los ectopicos, la cirugia radioguiada. Se seleccionaron 15 pacientes (80% mujeres) con adenomas ectopicos y se compararon con 143 adenomas ortotopicos. Se evaluaron: sexo, edad, localizacion, clinica, diagnostico bioquimico y topografico, peso glandular, vias de abordaje quirurgico, gradientes de descenso de PTH en la monitorizacion y resultados postoperatorios. Para la comparacion de medias se utilizo la U de Mann-Whitney y para las variables cualitativas el test de Fisher aceptando valores de p.0,05. RESULTADOS. Fueron ectopicos el 9,5% de los adenomas. 86,7% en paratiroides inferiores (4 mediastinicas) y 13,3% en superiores. La ectopia no modifico el comportamiento clinico de los adenomas (ambas series fueron similares). La sensibilidad diagnostica de la gammagrafia, en los ectopicos, fue 100% y para los normotopicos 80,5%. La TAC alcanzo el 66,7%, en los ectopicos, y 48,6% en los normotopicos y la Ecografia el 36,4% y 54%, respectivamente. En el grupo de adenomas ectopicos se utilizo la cervicotomia bilateral en 12 pacientes (80%), el abordaje selectivo en 3 y la sonda radioisotopica en 4. Las glandulas ectopicas extirpadas fueron adenomas. En el grupo normotopico se eligio el abordaje selectivo en el 55%. La comparacion de grupos no mostro diferencias de los parametros evaluados, salvo en la localizacion de los adenomas, mayor en las paratiroides inferiores (86,7% vs 68%) (p 2. No hubo diferencias clinicas entre los ectopicos y normotopicos. 3. La gammagrafia fue la prueba mas sensible (100%) para detectarlos. EnglishOBJECTIVES. To present the clinical-surgical peculiarities of ectopic parathyroid adenomas, comparing them to those of the normotopic adenomas. To determine the value of the diagnostic tests in ensuring therapeutic success. MATERIAL AND METHODS. Prospective study of 158 patients operated on for primary hyperparathyroidism (1998-2010), in which 83% were women, average age 62.8 years±13.7. For the topographic diagnostic, the gammagraph was used with Tecnecio-sestamibi, ultrasound and CAT (occasional) and to ensure the surgical exeresis, the intraoperative monitoring of PTH and, possible radio-guided surgery in the ectopic adenomas. Fifteen patients were selected (80% women) with ectopic adenomas and they were compared with 143 orthotopic adenomas. The following were evaluated: Gender, age, location, clinical symptoms, biochemical diagnosis, and topography, glandular weight, channels for surgical approach, degrees of decrease of PTH in the monitoring and postoperative results. For the comparison of means, the U of Mann-Whitney was used and the Fisher test was used for the qualitative variable, accepting values of p.0.05. RESULT. Of the adenomas, 9.5% were found to be ectopic; 86.7% in inferior parathyroids (4 mediastinal) and 13.3% in superior parathyroids. The ectopia did not change the clinical behaviour of the adenomas (both series were similar). The diagnostic sensitivity of the gammagraphy, in the ectopic adenomas, was 100% and for the normotopic 80.5%. The CAT achieved 66.7% in the ectopic and 48.6% in the normotopic; and the ultrasound achieved 36.4% and 54%, respectively. In the group of ectopic adenomas, the bilateral cervicotomy was used on 12 patients (80%), the selective approach on 3 and the radioisotopic probe on 4. The removed ectopic glands were adenomas. In the normotopic group, the selective approach was chosen in 55%. The comparison of the groups did not show differences of the evaluated parameters, except in the location of the adenomas, greater in the inferior parathyroids (86.7% vs. 68%) (p CONCLUSIONS: 1. The ectopic adenomas constituted 9.5%. More frequent in the inferior glands (86.4%). 2. There were no clinical differences between the ectopic and normotopic adenomas. 3. The gammagraph was the most sensitive test (100%) for detecting them.