Thallium/Technetium Subtraction Scanning for Primary Hyperparathyroidism: Scan Sensitivity and Effect on Operative Time

1998 ◽  
Vol 77 (5) ◽  
pp. 404-407 ◽  
Author(s):  
Justin A. Bergman ◽  
Ronald Pallant
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Operative Time ◽  
Elevated Serum ◽  
Surgical Exploration ◽  
Sestamibi Scanning ◽  
Subtraction Scanning

Over a ten-year period 26 patients were evaluated by the authors for elevated serum calcium and parathormone levels. All patients were clinically asymptomatic and were referred for parathyroid evaluation following a diagnosis of hypercalcemia made on routine SMA-12 studies. Twenty-four patients had positive thallium/technetium subtraction studies; two were suggestive of bilateral adenomata, one of which was confirmed at surgery. In two patients both thallium/technetium and technetium sestamibi scanning studies were negative. These patients were managed medically without surgical exploration. In all operative cases the patients remained normocalcemic during a six-month follow-up period. Operative times in all cases were less than one hour.

Psychiatric Illness in a Large Family with Familial Hyperparathyroidism

1970 ◽  
Vol 117 (541) ◽  
pp. 693-698 ◽  
Author(s):  
Thomas A. Flanagan ◽  
Donald W. Goodwin ◽  
Philip Alderson
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Psychiatric Illness ◽  
Incidental Finding ◽  
Family Members ◽  
Elevated Serum ◽  
Large Family ◽  
The Family ◽  
Familial Hyperparathyroidism

In 1964 Cutler et al. (1) reported on a family in which 11 members apparently had primary hyperparathyroidism. Seven cases were diagnosed at surgery; four other members had elevated serum calcium and other evidence of the disease. It was noted as an incidental finding that two of the affected members also suffered from severe psychiatric illness. The present study is a six-year follow-up investigation of the family from a psychiatric viewpoint, using non-hyperparathyroidism family members as controls to explore the possible relation of hyperparathyroidism to psychiatric illness.

Surgical Therapy for Familial Hyperparathyroidism

2009 ◽  
Vol 75 (7) ◽  
pp. 579-583 ◽  
Author(s):  
Jyotirmay Sharma ◽  
Collin J. Weber
Keyword(s):  
Primary Hyperparathyroidism ◽  
Cure Rate ◽  
Patient Demographics ◽  
Initial Surgery ◽  
Sestamibi Scanning ◽  
Recurrence Patterns ◽  
Sporadic Primary Hyperparathyroidism ◽  
Intraoperative Parathyroid Hormone ◽  
Familial Hyperparathyroidism

Isolated familial hyperparathyroidism (FHPT) not associated with multiple endocrine neoplasia is a rare and aggressive form of primary hyperparathyroidism. The traditional management of FHPT is a bilateral neck exploration with an increased rate of multigland hyperplasia, supernumerary glands, and recurrence. A prospective database was queried, which included 1383 consecutive parathyroidectomies between 1992 and 2008, and 28 patients with FHPT were identified. Patient demographics, pathology, intraoperative parathyroid hormone (IOPTH) kinetics, recurrence patterns, and accuracy of localization studies were analyzed. Twenty-one patients underwent bilateral neck explorations as an initial surgery, and seven patients had nine unilateral neck explorations for recurrent hyperparathyroidism. Overall cure rate was 89.2 per cent with a mean follow-up of 2.9 years (range: 6 months to 9.2 years); 64.3 per cent of patients had multigland disease. IOPTH helped identify supernumerary glands in three (12.5%) patients and accurately lateralized recurrent disease in eight of nine surgeries (88.8%). Tc-99m-Sestamibi failed to identify multigland disease in 11 patients (52.3%). FHPT has a greater prevalence of multigland disease, decreased utility of sestamibi scanning, and a higher recurrence rate than sporadic primary hyperparathyroidism. In FHPT, IOPTH is a useful adjunct in identifying additional tumors and in select cases may play a role in tumor localization.

scholarly journals Persistent disease after surgery for primary hyperparathyroidism: the long-term outcome

2004 ◽  
pp. 19-25 ◽  
Author(s):  
G Hedback ◽  
A Oden
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Bone Fractures ◽  
State Of Health ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Persistent Disease ◽  
Long Time ◽  
Extensive Surgery

OBJECTIVE: Nineteen patients with persistent primary hyperparathyroidism were investigated to evaluate their clinical and laboratory status a long time after treatment was ended. The risk of persistent disease and need for extensive surgery for cure, i.e. more than two neck operations, or mediastinal exploration, was also evaluated. DESIGN: The medical records of 896 consecutive patients operated on for primary hyperparathyroidism were scrutinised at follow-up, a mean of 10.3 Years after surgery. Data on state of health, medication, bone fractures and other diagnoses were collected by use of a questionnaire. There were 600 patients still alive, among whom 13 had persistent disease and they were compared with 509 patients who were cured and without any suspicion of recurrent disease, according to laboratory examination. RESULTS: Serum calcium and creatinine values had with few exceptions remained stable over the Years. In five patients, serum calcium levels were within the normal range at follow-up. Still, all 19 patients were considered hyperparathyroid. They had substantial cardiovascular morbidity, and their state of health was not as good as that of the patients who were surgically cured. After one operation, 5.5% (95% confidence interval (CI) 4.0-7.2%) had persistent disease, and 2.1% after reoperation. Extensive surgery for cure was performed in 2% of the patients (95% CI 1.1-3.2%). CONCLUSIONS: We found that the state of health was significantly better for patients with cured primary hyperparathyroidism than for patients with persistent disease, but serious deterioration of laboratory values was uncommon. The result of the present study supports surgical treatment.

scholarly journals Multiple ectopic parathyroid adenomas

2004 ◽  
Vol 122 (1) ◽  
pp. 32-34 ◽  
Author(s):  
Rogério Aparecido Dedivitis ◽  
André Vicente Guimarães ◽  
Gustavo Bastos de Goes Pontes
Keyword(s):  
Primary Hyperparathyroidism ◽  
Histopathological Examination ◽  
Thyroid Cartilage ◽  
Elevated Serum ◽  
Neck Surgery ◽  
Tissue Mass ◽  
Serum Total Calcium ◽  
Parathyroid Adenomas ◽  
Sestamibi Scanning ◽  
Ectopic Parathyroid

CONTEXT: Primary hyperparathyroidism is the most common cause of hypercalcemia in unselected patients. The ectopic gland locations should be known for appropriate surgical exploration and for avoiding subsequent re-exploration that would represent higher morbidity. Multiple ectopic glands are rare and present a particular challenge in parathyroid surgery. CASE REPORT: A 65-year-old female presented with nephrolithiasis. Her serum total calcium was found to be elevated. The diagnosis of primary hyperparathyroidism was confirmed by the elevated serum intact parathyroid hormone levels. Ultrasound was only successful in localizing one adenoma in the lower right gland. Technetium sestamibi scanning correctly localized the same adenoma and showed another contralateral image, lateral to the thyroid cartilage. Fiber optic laryngoscopy showed an extrinsic mass pushing against the lateral and posterior walls of the left pyriform sinus. Resonance imaging revealed a soft tissue mass. RESULTS: The patient underwent bilateral neck exploration. Histopathological examination confirmed the diagnosis of parathyroid double adenomas. The late-stage postoperative checkups were normal. DISCUSSION: Routine bilateral neck surgery should be performed as a rule. We use ultrasound and technetium sestamibi scanning as a routine for preoperative localization studies. It is helpful to have an experienced surgeon for the localization.

scholarly journals The Technique of Intraoperative Nuclear Mapping to Facilitate Minimally Invasive Parathyroidectomy

1997 ◽  
Vol 4 (6) ◽  
pp. 500-504 ◽  
Author(s):  
James Norman
Keyword(s):  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Outpatient Setting ◽  
Minimally Invasive Parathyroidectomy ◽  
Invasive Technique ◽  
Single Adenoma ◽  
Surgical Exploration ◽  
Invasive Parathyroidectomy ◽  
Sestamibi Scan ◽  
Sestamibi Scanning

Background Despite the fact that primary hyperparathyroidism (HPTH) is the result of a single adenoma in 85% to 92% of cases and is cured following the removal of this one gland, many surgeons continue to perform a complete bilateral neck exploration for patients with primary HPTH. The advent of the sestamibi scan now enables the identification of patients with a single adenoma. Methods The use of preoperative sestamibi scanning followed immediately by minimally invasive parathyroidectomy using intraoperative nuclear mapping allows cure for primary HPTH in properly selected patients. Results Reports have shown that preoperative sestamibi scanning has a sensitivity of approximately 90% and a specificity of almost 100% in identifying patients with a single adenoma. Intraoperative mapping allows a limited dissection to be performed under local anesthesia in an outpatient setting in approximately 80% of all patients with primary hyperparathyroidism. The details of this new technique — patient selection, timing, use of the intraoperative nuclear probe, and surgical exploration — are described. Conclusions When selected appropriately, most patients with primary HPTH can be successfully treated through a minimally invasive technique.

Psychosis Resulting in Suicide in a Patient with Primary Hyperparathyroidism

1986 ◽  
Vol 31 (4) ◽  
pp. 342-343 ◽  
Author(s):  
Sueda Öztunç ◽  
Richard G. Guscott ◽  
Jorge Soni ◽  
Meir Steiner
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Serum Calcium ◽  
Clinical Condition ◽  
Elevated Serum ◽  
Surgical Removal ◽  
Organic Psychosis ◽  
Symptoms Of Depression ◽  
Normal Ranges ◽  
Biochemical Abnormalities

A case is reported of a patient presenting to the psychiatric unit of our hospital with symptoms of depression and found to have an organic psychosis. On routine SMA-12 investigation (12 channel auto analyzer), elevated serum calcium was detected on admission leading to the diagnosis of primary hyperparathyroidism (PHPT). The surgical removal of a parathyroid adenoma was followed by a rapid return of biochemical abnormalities to normal ranges. In spite of appropriate psychiatric management and fluctuations in the patient's clinical condition, the organic psychosis was unaltered and culminated in suicide 4 months after admission.

scholarly journals Normocalcemic primary hyperparathyroidism: long-term follow-up associated with multiple adenomas

2014 ◽  
Vol 58 (5) ◽  
pp. 583-586 ◽  
Author(s):  
Larissa Pimentel ◽  
Sirley Portela ◽  
Alyne Loureiro ◽  
Francisco Bandeira
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Normal Serum ◽  
T Score ◽  
Sestamibi Scan ◽  
Normal Serum Calcium ◽  
Long Term Follow Up ◽  
Serum Pth

Normocalcemic primary hyperparathyroidism (NPHPT) is a condition characterized by elevation of the parathyroid hormone (PTH) in the presence of normal serum calcium and the absence of secondary causes. The case described illustrates the long-term follow-up of a postmenopausal woman with NPHPT patient who progressed with multiple adenomas. This case reports a 77-year-old female who has chronic generalized pain and osteoporosis. Her initial serum PTH was 105 pg/mL, with total serum calcium of 9.6 mg/dL, albumin 4.79 g/dL, phosphorus 2.8 mg/dL, and 25OHD after supplementation was 34.6 ng/mL. The bone densitometry (BMD) results were as follows: lumbar spine: T-score -3.0, femoral neck: T-score -2.6 and distal radius: -4.2. Other causes of secondary hyperparathyroidism were ruled out and cervical ultrasound and Tc-99-Sestamibi scan were negative. She used oral alendronate and three infusions of zoledronic acid for treatment of osteoporosis. In the 10th year of follow-up, after successive negative cervical imaging, ultrasound showed a nodule suggestive of an enlarged right inferior parathyroid gland. PTH levels in fluid which was obtained during fine-needle aspiration (FNA) were over 5,000 pg/mL and a Sestamibi scan was negative. The patient underwent parathyroidectomy, and a histological examination confirmed parathyroid adenoma. Post-operatively serum PTH remained elevated in the presence of normal serum calcium levels. A follow-up cervical ultrasound showed a new solid nodule suggestive of an enlarged right superior parathyroid gland. PTH levels in the aspiration fluid were remarkably high. A second parathyroidectomy was performed, with the excision of a histologically confirmed parathyroid adenoma. In conclusion, this is an unusual presentation of NPHPT and highlights the long-term complications.

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