HIGH CERVICAL INTRAVAGAL HYPERCELLULAR PARATHYROID-GLAND AS THE ETIOLOGY OF SEVERE PERSISTENT PRIMARY HYPERPARATHYROIDISM

The preoperative localization and operative management of a high cervi cal intravagal parathyroid adenoma in a young woman with severe persis tent primary hyperparathyroidism is presented. The etiology of persist ent hyperparathyroidism is most frequently a missed adenoma that is of ten in an ectopic location; of these, undescended adenomas represent a small but important proportion. If clinical suspicion and preoperativ e localization procedures suggest an undescended gland, a direct surgi cal approach using a high cervical incision and a unilateral explorati on is often successful.