Multiple ectopic parathyroid glands

Parathyroid surgery to correct primary hyperparathyroidism is successful in 80 to 97 per cent of initial explorations. Failures are often linked to in ability to locate ectopic parathyroid glands. Although ectopic parathyroid glands are relatively common (15%) multiple ectopic glands are rarely repor ted. We describe a case of multiple ectopic parathyroid glands and the intr aoperative approach to their localization and review the anatomy and embryo logy of ectopic parathyroid glands. A 39-year-old woman presented with fati gue, lethargy, and depression. On biochemical evaluation she was noted to b e hypercalcemic and hyperparathyroid. Preoperative parathyroid localization failed to identify abnormal parathyroid glands. At exploration three of fo ur parathyroid glands, including an adenoma, were located in ectopic positi ons by a meticulous and systematic dissection. A careful exploration couple d with a thorough knowledge of parathyroid anatomy and embryology will prod uce successful surgical correction of primary hyperparathyroidism in greate r than 95 per cent of patients even in the few patients with multiple ectop ic parathyroid glands.