부갑상선 선종 제거술 22년 후에 재발한 이소성 부갑상선 선종

재발성 부갑상선 선종은 드물며 재발의 원인에 대해서는 뚜렷이 밝혀진 바가 없다. 재발했을 경우 첫 수술에 비해 기술적으로 어렵고 수술 후 합병증이 생길 가능성이 많으므로 수술 전 영상 기법을 통해서 국소화하고 수술 중 부갑상선 호르몬 감시를 통해서 수술 성공 여부를 가늠해야 한다. 저자들은 부갑상선 선종 제거술 22년 후에 우측 악하선에 재발한 이소성 부갑상선 선종을 체험하였기에 문헌 고찰과 함께 보고하는 바이다. Persistent or recurrent primary hyperparathyroidism after initial parathyroid surgery occurs at rates of 1.5~10%. A single missed parathyroid adenoma accounts for the majority of persistent hyperparathyroidism, whereas metachronous parathyroid adenoma is a rare cause of recurrent hypercalcemia. We report a case of a 39-year-old female who presented with recurrent pancreatitis. She had symptoms of hyperparathyroidism such as hypercalcemia, hypophosphatemia, hypercalciuria, nephrocalcinosis, and osteoporosis. She had a 2-cm firm neck mass under the right submandibular area. She was diagnosed with primary hyperparathyroidism 22 years ago. At that time, the right upper and lower parathyroid glands were removed after exploration of all parathyroid glands, and a right upper parathyroid adenoma was diagnosed. Now, she had a second surgery to remove the right submandibular mass with intraoperative PTH monitoring, which was diagnosed as a parathyroid adenoma in an ectopic supernumerary parathyroid gland. Because of hungry bone syndrome, she received calcium carbonate replacement therapy and has no evidence of recurrence. Here, we report a recurrent parathyroid adenoma in the undescended, supernumerary parathyroid gland after a long interval from the initial surgery. (J Korean Endocr Soc 24:260~264, 2009)