Giant Parathyroid Lesion

ABSTRACT Background Parathyroid carcinoma is a rare entity that has diverse presentation and diverse treatments. This case-series highlights the atypical and diverse presentation of parathyroid carcinoma and stresses the importance of the diagnostic approach and intraoperative strategy. Methods We report three patients with parathyroid cancer. Results In one patient, a parathyroid lesion was found to be a parathyroid carcinoma intraoperatively, resulting in a change of operative strategy. In another, parathyroid carcinoma was suspected preoperatively and was treated accordingly. A third patient presented with an already a metastasized parathyroid carcinoma. Conclusion The diagnostic approach and intraoperative strategy are instrumental to determining the best treatment and yielding the best outcome.

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Recurrent Hyperparathyroidism Due to a Rare Submental Ectopic Parathyroid Lesion in a Dialysis Patient

The Endocrinologist ◽

10.1097/ten.0b013e3181b60952 ◽

2009 ◽

Vol 19 (5) ◽

pp. 218-219

Author(s):

Aydin Unal ◽

Murat Hayri Sipahioglu ◽

Mustafa Kula ◽

Bulent Tokgoz ◽

Oktay Oymak ◽

...

Keyword(s):

Dialysis Patient ◽

Ectopic Parathyroid ◽

Recurrent Hyperparathyroidism ◽

Parathyroid Lesion

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Novel Method in Performing PTH Washout for Localizing Parathyroid Adenoma: Case Report & an Institute Experience in Qatar

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.538 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A265-A266

Author(s):

Obada Khalil Mohammad Salameh ◽

Wajiha Gul ◽

Noora Al-Thani ◽

Zaina Abdelhalim Alamer ◽

Tarik A Elhadd ◽

...

Keyword(s):

Surgical Removal ◽

Pathology Report ◽

Post Surgery ◽

Control Tube ◽

Benign Adenoma ◽

Sestamibi Scan ◽

Novel Method ◽

Diagnostic Modalities ◽

Operative Findings ◽

Parathyroid Lesion

Abstract Introduction: Primary hyperparathyroidism (PHPT) is a common cause of hypercalcemia and mostly caused by benign solitary benign adenoma (80 to 85 %). Definite treatment is the surgical removal. The most commonly used diagnostic modalities are Sestamibi scan and neck ultrasound (US) which can be inconclusive in some cases. Parathyroid hormone (PTH) washout obtained with ultrasound guided FNA may be useful to accurately localize the adenoma. In our study we describe a novel method for PTH washout. Methods: First, blood samples are drawn from the patient’s peripheral vein and placed in two yellow top tubes (3 ml of blood in each tube). 1 ml of normal saline (NS) will be add to Tube # 1 (Control tube). The suspected parathyroid lesion aspirate is obtained via US guided FNA. It is washed in 1 ml of NS and added to tube #2 (PTH washout tube). Both tubes are sent to our local laboratory for PTH assay. The ratio of PTH in PTH washout tube to control tube (PTH W/C ratio) is calculated and considered positive if more than 2. Results: Total 16 patients (12 females and 4 males) underwent the PTH washout procedure. All patients had PHPT. Out of 16 patients, 13 had inconclusive Sestamibi scan while 3 patients didn’t have the scan due to pregnancy. PTH W/C ratio was positive in 13 patients (ruled in) and negative (ruled out) in 3 patients. All patients underwent parathyroid surgery. The operative findings and pathology report were consistent with PTH W/C ratio findings. i.e. parathyroid hypercellularity was found in all the 13 patients ruled in by PTH W/C ratio. Post-surgery, biochemical parameters normalized in all. Conclusion: PTH washout is an important tool in localizing parathyroid lesion in PHPT when Sestamibi scan cannot be done or if it is inconclusive. PTH W/C ratio can be performed with our novel method to accurately localize the PTH lesion and improve surgical outcome.

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Usefulness of SPECT/CT in Parathyroid Lesion Detection in Patients with Thyroid Parenchymal 99mTc-Sestamibi Retention

Nuclear Medicine and Molecular Imaging ◽

10.1007/s13139-016-0438-5 ◽

2016 ◽

Vol 51 (1) ◽

pp. 32-39 ◽

Cited By ~ 11

Author(s):

Sang Hyun Hwang ◽

Yumie Rhee ◽

Mijin Yun ◽

Jung Hyun Yoon ◽

Jeong Won Lee ◽

...

Keyword(s):

Lesion Detection ◽

Parathyroid Lesion ◽

99Mtc Sestamibi

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Hyperparathyroidism in pregnancy

BMJ Case Reports ◽

10.1136/bcr-2019-232653 ◽

2020 ◽

Vol 13 (2) ◽

pp. e232653

Author(s):

Catherine Davis ◽

Tanya Nippita

Keyword(s):

Intrauterine Growth Restriction ◽

Hyperemesis Gravidarum ◽

Elevated Serum ◽

Male Infant ◽

Clinical Suspicion ◽

Growth Restriction ◽

Intrauterine Growth ◽

Parathyroid Tumour ◽

History Of ◽

Parathyroid Lesion

Hyperparathyroidism is a rare disease during pregnancy, which has increased risks, including miscarriage and fetal growth restriction. However, the diagnosis of hyperparathyroidism is frequently not recognised or delayed as symptoms are non-specific and calcium is not routinely measured. With a thorough medical history and clinical suspicion, early diagnosis and treatment can reduce the risk of some pregnancy complications. A 35-year-old woman presented at 13/40 with hyperemesis gravidarum. She had elevated serum calcium and a parathyroid lesion on ultrasound. She underwent a parathyroidectomy with rapid normalisation of her calcium. Histopathology confirmed a parafibromin-deficient parathyroid tumour, suggestive of hyperparathyroidism jaw tumour syndrome. At 30/40, she presented with pre-eclampsia (hypertension, hyper-reflexia, proteinuria and intrauterine growth restriction) and had a caesarean section at 30+1/40, delivering a male infant, 897 g (fifth percentile). She had a prior 12-month history of chronic constipation and nephrolithiasis but was not investigated further despite elevated calcium (2.82 mmol/L).

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Phantom experiments to improve parathyroid lesion detection

Medical Physics ◽

10.1118/1.2804553 ◽

2007 ◽

Vol 34 (12) ◽

pp. 4792-4797 ◽

Cited By ~ 1

Author(s):

Kenneth J. Nichols ◽

Gene G. Tronco ◽

Maria B. Tomas ◽

Biju D. Kunjummen ◽

Lisa Siripun ◽

...

Keyword(s):

Lesion Detection ◽

Phantom Experiments ◽

Parathyroid Lesion

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Primary hyperparathyroidism with surgical indication and negative or equivocal scintigraphy: safety and reliability of PTH washout. A systematic review and meta-analysis

Acta Endocrinologica ◽

10.1530/eje-19-0160 ◽

2019 ◽

Vol 181 (3) ◽

pp. 245-253 ◽

Cited By ~ 3

Author(s):

Marco Castellana ◽

Camilla Virili ◽

Andrea Palermo ◽

Francesco Giorgino ◽

Luca Giovanella ◽

...

Keyword(s):

Systematic Review ◽

Primary Hyperparathyroidism ◽

Predictive Value ◽

Diagnostic Performance ◽

Meta Analysis ◽

Safety And Reliability ◽

Major Procedure ◽

Accurate Procedure ◽

Operating Points ◽

Parathyroid Lesion

Objective Despite the improvements in ultrasound (US) and scintigraphy, 10–20% of patients with primary hyperparathyroidism (PHPT) still have discordant findings. We performed a systematic review and meta-analysis to assess the safety and the diagnostic performance of US-guided PTH washout (FNA-PTH) in patients with PHPT, a suspected parathyroid lesion on US but negative or equivocal scintigraphy. Methods The review was registered on PROSPERO (CRD42019124249). PubMed, Scopus, CENTRAL and Web of Science were searched until February 2019. Original articles reporting complications and diagnostic performance of FNA-PTH in biochemically and histopathologically diagnosed PHPT were selected. The risk of bias of included studies was assessed through QUADAS-2. Summary operating points were estimated using a random-effects model. Results Out of 2573 retrieved papers, nine cohort studies were included in the review. No major procedure-related complications were found. Pooled sensitivity was 95% (95% CI: 91–98; I 2: = 14%) and positive predictive value was 97% (95% CI: 93–100; I 2: = 39%). There were not enough data for specificity and negative predictive value to perform a meta-analysis. However, pooling results of all lesions, they were estimated to be 83 and 73%, respectively. Conclusions In patients with biochemically proven PHPT and discordant imaging, FNA-PTH was a safe and accurate procedure. In this specific setting of patients, FNA-PTH could be used as a rule-in test for minimally invasive parathyroidectomy.

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Could the eZ-SCOPE AN Gamma Camera Replace Intraoperative Measurement of iPTH for PHPT?

International Surgery ◽

10.9738/cc138.1 ◽

2012 ◽

Vol 97 (2) ◽

pp. 99-103 ◽

Cited By ~ 3

Author(s):

Takaaki Fujii ◽

Reina Yajima ◽

Satoru Yamaguchi ◽

Soichi Tsutsumi ◽

Takayuki Asao ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Gamma Camera ◽

Complete Removal ◽

Complete Resection ◽

Technetium 99M Sestamibi ◽

Navigation Surgery ◽

Preliminary Study ◽

Mibi Scintigraphy ◽

Intraoperative Ipth Assay ◽

Parathyroid Lesion

Abstract Intraoperative intact parathyroid hormone (iPTH) measurements have been proposed as an effective assay in surgery for primary hyperparathyroidism (PHPT). We have demonstrated the efficiency of the use of a hand-held gamma camera, eZ-SCOPE AN, with technetium-99m sestamibi (Tc-MIBI) scintigraphy for navigation surgery for PHPT. The aim of this preliminary study was to assess the possibility that the eZ-SCOPE AN can replace the measurement of intraoperative iPTH in surgery for PHPT. Sixteen consecutive patients with documented primary hyperparathyroidism underwent surgery using this compact camera. iPTH was routinely measured preoperatively and 10 minutes after the complete removal of adenoma. All patients had a well-defined parathyroid lesion identified on preoperative Tc-MIBI. The eZ-SCOPE revealed hyperfunctioning parathyroid glands in all cases. iPTH levels were decreased in all cases after the removal of adenomas. Our results suggest that this gamma camera is useful for confirming complete resection of endocrinologically active tissue in surgery for PHPT. In selective patients with scan-positive cases identified by preoperative Tc-MIBI, the eZ-SCOPE may replace the intraoperative iPTH assay in surgery for PHPT.

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