scholarly journals Selective venous sampling supports localization of adenoma in primary hyperparathyroidism

2018 ◽  
Vol 7 (2) ◽  
pp. 205846011876036
Author(s):  
Masaya Ikuno ◽  
Takayuki Yamada ◽  
Yasumoto Shinjo ◽  
Tsuyoshi Morimoto ◽  
Reiko Kumano ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Tissue ◽  
Imaging Study ◽  
Surgical Removal ◽  
Venous Sampling ◽  
Selective Venous Sampling ◽  
Non Invasive ◽  
Institutional Review ◽  
Ultrasound Computed Tomography ◽  
Mibi Scintigraphy

Background Selective venous sampling (SVS) is an invasive localization study for persistent or recurrent hyperparathyroidism. Purpose To assess the role of SVS in addition to non-invasive imaging for primary hyperparathyroidism (pHPT). Material and Methods This study was approved by the institutional review board and included 14 patients who underwent SVS and subsequent parathyroidectomy between January 2014 and April 2017 following a clinical diagnosis of pHPT. All patients underwent pre-SVS non-invasive imaging, including ultrasound, computed tomography (CT), and 99mTc-MIBI scintigraphy, and sensitivity was assessed using the operative and pathological findings. Results In all but one case, a single parathyroid adenoma was responsible for the pHPT; the remaining case exhibited a chemical response following surgical removal of parathyroid tissue. The sensitivity (%) for ultrasound, CT, 99mTc-MIBI scintigraphy, and SVS was 76.9, 84.6, 69.2, and 76.9, respectively. SVS yielded positive results in four patients with discordant results and one patient with non-detectable results on imaging. In seven patients, a significant increase in the intact parathyroid hormone level was recognized only in the thyroid veins. The procedure time was in the range of 52–183 min (median = 89.5 min). Conclusion The addition of SVS to a non-invasive imaging study would be helpful to locate the responsible lesion of pHPT with discordant or non-detectable results on imaging for initial surgical treatment as well.

scholarly journals Bone and Mineral Metabolism Phenotypes in MEN1-Related and Sporadic Primary Hyperparathyroidism, before and after Parathyroidectomy

Cells ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1895
Author(s):  
Francesca Marini ◽  
Francesca Giusti ◽  
Federica Cioppi ◽  
Davide Maraghelli ◽  
Tiziana Cavalli ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bone Mass ◽  
Bone Metabolism ◽  
Mineral Metabolism ◽  
Parathyroid Tissue ◽  
Young Patients ◽  
Surgical Removal ◽  
Mineral Density ◽  
Bone Mass Loss ◽  
Before And After

Primary hyperparathyroidism (PHPT) is the most common endocrinopathy in multiple endocrine neoplasia type 1 (MEN1). Persistent levels of increased parathyroid hormone (PTH) result in a higher incidence of osteopenia and osteoporosis compared to the general population. Surgical removal of hyper-functioning parathyroid tissue is the therapy of choice. This retrospective study evaluated the effect of parathyroidectomy (PTX) on bone metabolism and bone mass in two series of patients with MEN1 PHPT and sporadic PHPT (sPHPT) by comparing bone metabolism-related biochemical markers and bone mineral density (BMD) before and after surgery. Our data confirmed, in a higher number of cases than in previously published studies, the efficacy of PTX, not only to rapidly restore normal levels of PTH and calcium, but also to normalize biochemical parameters of bone resorption and bone formation, and to improve spine and femur bone mass, in both MEN1 PHPT and sPHPT. Evaluation of single-patient BMD changes after surgery indicates an individual variable bone mass improvement in a great majority of MEN1 PHPT patients. In MEN1 patients, PTX is strongly suggested in the presence of increased PTH and hypercalcemia to prevent/reduce the early-onset bone mass loss and grant, in young patients, the achievement of the bone mass peak; routine monitoring of bone metabolism and bone mass should start from adolescence. Therapy with anti-fracture drugs is indicated in MEN1 patients with BMD lower than the age-matched normal values.

Surgeon-Performed Ultrasound Improves Localization of Abnormal Parathyroid Glands

2005 ◽  
Vol 71 (7) ◽  
pp. 557-563 ◽  
Author(s):  
Carmen C. Solorzano ◽  
Theresa M. Lee ◽  
Marcela C. Ramirez ◽  
Denise M. Carneiro ◽  
George L. Irvin
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Thyroid Tissue ◽  
Parathyroid Tissue ◽  
Initial Step ◽  
Multiglandular Disease ◽  
Venous Sampling ◽  
Sporadic Primary Hyperparathyroidism ◽  
Operative Findings ◽  
Abnormal Tissue

With a secure diagnosis of hyperparathyroidism, preoperative localization of abnormal glands is the initial step toward limited parathyroidectomy (LPX). We investigated whether ultrasonography in the hands of the surgeon (SUS) could improve the localization of abnormal parathyroids when sestamibi scans (MIBI) were negative or equivocal. One hundred eighty patients with sporadic primary hyperparathyroidism (SPHPT) underwent preoperative SUS and MIBI scans before LPX guided by intraoperative parathormone assay. When the sestamibi scans were negative, SUS was used to localize the parathyroid, distinguish parathyroid from thyroid tissue, and to guide the intraoperative jugular venous sampling for differential elevation of parathyroid hormone (PTH). Operative findings, intraoperative hormone dynamics, and postoperative calcium levels determined successful localization. MIBI was negative or equivocal in 36/180 (20%) patients: 1) showed no parathyroid gland in 22 patients, 2) suggested an incorrect location for the abnormal gland in 9, and 3) was insufficient in recognizing multiglandular disease in 5. In these 36 patients, the addition of SUS led to the successful identification of the abnormal tissue in 19/36 (53%). In the remaining 17 patients with negative/equivocal scans, the parathyroid could not be clearly visualized by SUS. In these patients, SUS facilitated LPX by aiding preoperative transcutaneous jugular venous sampling for differentially elevated PTH (n = 3) and identifying questionable thyroid nodule versus parathyroid tissue (n = 1). Overall, SUS was useful in 23/36 (67%) patients with nonlocalizing MIBI scans, thus improving the rate of localization from 80 per cent to 93 per cent ( P < 0.01). Surgeon-performed cervical ultrasonography improved the localization of abnormal parathyroids by MIBI scan, adding to the success of limited parathyroidectomy.

Super-selective venous sampling (S-SVS) with quick parathyroid hormone (PTH) assay for patients with persistent primary hyperparathyroidism

2019 ◽  
Vol 493 ◽  
pp. S333-S334
Author(s):  
S. Terzán-Molina ◽  
R. Pérez-Calleja ◽  
I. Miñambres-Donaire ◽  
R. Guerrero-Vara ◽  
A. Moral-Duarte ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Venous Sampling ◽  
Selective Venous Sampling

Selective venous sampling for primary hyperparathyroidism: how to perform an examination and interpret the results with reference to thyroid vein anatomy

2017 ◽  
Vol 35 (8) ◽  
pp. 409-416 ◽  
Author(s):  
Takayuki Yamada ◽  
Masaya Ikuno ◽  
Yasumoto Shinjo ◽  
Atsushi Hiroishi ◽  
Shoichiro Matsushita ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Venous Sampling ◽  
Selective Venous Sampling

scholarly journals Super-selective venous sampling in conjunction with quickPTH for patients with persistent primary hyperparathyroidism: report of five cases

Surgery Today ◽  
2012 ◽  
Vol 42 (6) ◽  
pp. 570-576 ◽  
Author(s):  
Oliver Gimm ◽  
Lars-Gunnar Arnesson ◽  
Pia Olofsson ◽  
Olallo Morales ◽  
Claes Juhlin
Keyword(s):  
Primary Hyperparathyroidism ◽  
Venous Sampling ◽  
Selective Venous Sampling

scholarly journals The role of selective venous sampling in patients with non-localized primary hyperparathyroidism

2020 ◽  
Vol 36 (2) ◽  
pp. 164-171
Author(s):  
İlhan Gök ◽  
Nuri Alper Şahbaz ◽  
Cevher Akarsu ◽  
Ahmet Cem Dural ◽  
Meral Mert ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Venous Sampling ◽  
Selective Venous Sampling

scholarly journals A clinical case of combined differentiated thyroid cancer and primary hyperparathyroidism: the complexity of topical differential diagnosis

2019 ◽  
Vol 65 (4) ◽  
pp. 243-250
Author(s):  
Konstantin Yu. Slashchuk ◽  
Mikhail V. Degtyarev ◽  
Sergey S. Serzhenko ◽  
Pavel O. Rumyantsev ◽  
Marina S. Sheremeta ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Differentiated Thyroid Cancer ◽  
Clinical Case ◽  
Adult Population ◽  
Parathyroid Tissue ◽  
Surgical Removal ◽  
Urgent Problem ◽  
Endocrine Diseases ◽  
Topical Diagnosis ◽  
Sporadic Primary Hyperparathyroidism

In recent years, the understanding of the epidemiology, symptoms and strategies for managing patients with hyperparathyroidism has changed significantly. The most common cases in clinical practice are of sporadic primary hyperparathyroidism, which today ranks third in prevalence among endocrine diseases (the frequency of occurrence in the adult population is, on average, 12%). In primary hyperparathyroidism, solitary parathyroid adenoma is detected in up to 85% of all cases. The only treatment is radical surgical removal of pathologically altered parathyroid tissue. Early diagnosis and treatment of hyperparathyroidism makes it possible to avoid severe lesions of the skeletal bones and visceral organs. A diagnostically challenging clinical case of a combined onco-endocrine pathology in a 70-year-old patient is presented. The main difficulties in the initial diagnosis were associated with the absence of pathognomonic symptoms of the disease, which was often completely asymptomatic. The most urgent problem appears to be the topical diagnosis of pathologically altered parathyroid glands. Therefore, there is a need to develop an algorithm for the combining and sequential use of existing medical imaging methods.

A Case of Parathyroid Carcinoma Visualized on Tc-99m-Sestamibi Scintigraphy

1997 ◽  
Vol 36 (07) ◽  
pp. 256-258 ◽  
Author(s):  
G. F. Fueger ◽  
S. Lax ◽  
Reingard Aigner
Keyword(s):  
Parathyroid Carcinoma ◽  
Histopathological Examination ◽  
Parathyroid Tissue ◽  
Sestamibi Scintigraphy ◽  
Parathyroid Adenomas ◽  
Mibi Scintigraphy

SummaryRecent studies indicate that Tc-99m-Sestamibi (MIBI, DuPont Pharma) is a useful tracer for detecting parathyroid adenomas. We present a patient with focal Tc-99m-MIBI uptake in parathyroid carcinoma which has only been described once before (1). Tc-99m-MIBI scintigraphy may be considered for diagnosing pathological parathyroid tissue. But presently the histopathological examination only allows the differentiation between adenoma and carcinoma.

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