Introduction: A missed parathyroid adenoma is an important cause of persistent or recurrent primary hyperparathyroidism. Despite the widespread use of preoperative localizing tests and the advent of the rapid intact blood parathyroid hormone assay (iPTH), difficult operative cases are encountered when abnormal parathyroid glands cannot be identified. Methods: Over a 5-year period, 466 neck explorations were performed for primary hyperparathyroidism. This retrospective report describes the use of intraoperative jugular venous sampling to locate and remove successfully undescended parathyroid adenomas in three patients. Results: Intraoperative jugular venous sampling for iPTH analysis was performed when a thorough neck exploration in combination with peripheral iPTH failed to reveal a source of hyperparathyroidism in patients with biochemically confirmed hyperparathyroidism. In all patients, a two- to fourfold iPTH gradient was observed between the affected and unaffected sides, and an undescended adenoma was located near the carotid bifurcation. Conclusions: Intraoperative jugular venous sampling with iPTH analysis may be a useful technique for successfully detecting an undescended adenoma when other, more routine measures have failed.
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