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.

Value of Ultrasonography, CT and MR Imaging in the Diagnosis of Primary Hyperparathyroidism

1996 ◽  
Vol 37 (3P2) ◽  
pp. 720-726 ◽  
Author(s):  
C. Tziakouri ◽  
E. Eracleous ◽  
S. Skannavis ◽  
A. Pierides ◽  
P. Symeonides ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Primary Hyperparathyroidism ◽  
Detection Rate ◽  
Cost Effective ◽  
Clinical Results ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Confirmatory Test ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid

Purpose: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgical outcome in patients with primary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in 87% of these patients. Conclusion: US, CT and MR imaging followed by surgery performed by an experienced surgeon provided good clinical results in 39 patients with primary hyperparathyroidism. Preoperative localization was especially useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the root of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery.

scholarly journals Preoperative 4D CT Scan Facilitates Localization of Small and Ectopic Parathyroid Adenomas in Primary Hyperparathyroidism

2021 ◽  
Vol 233 (5) ◽  
pp. S67-S68
Author(s):  
Regina Matar ◽  
Katherine Jackson ◽  
Michael Wright ◽  
Deanna Cotsalas ◽  
Susan Hobbs ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ct Scan ◽  
4D Ct ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid

Results of ultrasonically guided percutaneous ethanol injection into parathyroid adenomas in primary hyperparathyroidism

1993 ◽  
Vol 129 (5) ◽  
pp. 381-387 ◽  
Author(s):  
Bruno L Vergès ◽  
Jean P Cercueil ◽  
Denis Jacob ◽  
Geneviève Vaillant ◽  
Jean M Brun ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Histopathological Examination ◽  
Alternative Therapy ◽  
Percutaneous Ethanol Injection ◽  
Plasma Calcium ◽  
Ethanol Injection ◽  
Parathyroid Adenomas ◽  
Calcium Phosphorus ◽  
Partial Success

Surgery is the usual treatment for primary hyperparathyroidism. However, some patients with high surgical risks are not suitable for surgery. For such patients, we propose, as an alternative treatment, ultrasonically guided percutaneous ethanol injection into parathyroid adenomas, in order to induce necrosis of the tumor. We report, here, the results of ultrasonically guided percutaneous ethanol injection into parathyroid adenomas, during a prolonged follow-up period up to 49 months, in a group of 13 patients (median age 79 years) with primary hyperparathyroidism and contraindications for surgery. In seven patients, complete normalization of plasma calcium, phosphorus and parathyroid hormone (PTH) levels was achieved after ethanol injections, with no recurrence of hypercalcemia during a median follow-up period of 28 months (total success). In these seven patients, plasma calcium, phosphorus and PTH levels were normalized 48 h after the successful ethanol injection. In four patients, a partial success was obtained with clinical improvement and normalization of plasma calcium levels but without complete normalization of plasma PTH levels. This partial success is due to incomplete necrosis of the adenoma, as has been confirmed in one patient by histopathological examination. The ethanol injection treatment failed in only two patients. This treatment was always well tolerated and no major side-effects were observed. In conclusion, our results give evidence that ultrasonically guided percutaneous ethanol injection into parathyroid adenomas can be a very useful alternative therapy in patients not suitable for surgery.

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.

Accuracy of Dual Phase Single-Photon Emission Computed Tomography/Computed Tomography in Primary Hyperparathyroidism: Correlation with Serum Parathyroid Hormone Levels

2016 ◽  
Vol 67 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Wade Koberstein ◽  
Christopher Fung ◽  
Kristy Romaniuk ◽  
Jonathan T. Abele
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Predictive Value ◽  
Single Photon ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Dual Phase ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid ◽  
Serum Pth

Purpose The objectives of this study were: 1) to determine the accuracy of dual-phase 99mTc -methoxyisobutylisonitrile (MIBI) with single-photon emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of parathyroid adenomas in the setting of primary hyperparathyroidism; 2) to determine the accuracy of localization for ectopic glands; and 3) to assess the relationship between accuracy and serum parathyroid hormone (PTH) levels. Methods Eighty-eight patients who underwent 99mTc-MIBI SPECT/CT imaging for primary hyperparathyroidism at our institution over a 27-month period were retrospectively assessed. The preoperative SPECT/CT results were compared to intraoperative findings (within 1 year of imaging). The relationship between serum PTH level (within 3 months) and SPECT/CT accuracy was then evaluated. Results Accuracy indices for the retrothyroid subgroup were sensitivity 86.7%, specificity 96.4%, positive predictive value 98.1%, negative predictive value 77.1%, and accuracy 89.8%. Accuracy indices for ectopic parathyroid adenomas were sensitivity 81.5%, specificity 100%, positive predictive value 100%, negative predictive value 92.4%, and accuracy 94.3%. For the overall group, SPECT/CT demonstrated a sensitivity of 85.1% and a PPV of 98.7%. SPECT/CT correctly identified the abnormal parathyroid gland in 60% of patients with a normal serum PTH (<6.9 pmol/L), 73% between 6.9-9.9 pmol/L, 86% between 10.0-14.9 pmol/L, 100% between 15.0-19.9 pmol/L, 88% between 20.0-24.5 pmol/L, and 100% of patients with a PTH greater than 25.0 pmol/L. Conclusions Dual-phase 99mTc- MIBI with SPECT/CT is an accurate and reliable means to correctly localize both retrothyroid and ectopic parathyroid adenomas for the purpose of surgical planning. The accuracy of SPECT/CT increases with increasing serum PTH levels.

scholarly journals Intrathyroid parathyroid adenoma: report of two cases and literature review

2020 ◽  
Vol 8 (11) ◽  
pp. 4096
Author(s):  
Camilo Levi Acuna Pinzon ◽  
Eduardo Morales Valencia ◽  
Jefferson Nieves Condoy ◽  
Luis Abraham Zuniga Vasquez ◽  
Arturo Jorge Sotelo
Keyword(s):  
Literature Review ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Clinical Suspicion ◽  
Definitive Treatment ◽  
Preoperative Period ◽  
Imaging Studies ◽  
High Clinical Suspicion ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid

Approximately 80% of patients with primary hyperparathyroidism have a parathyroid adenoma, with surgery being the only definitive treatment. Sometimes in surgery there is difficulty in identifying the pathological parathyroid gland at which time the possibility of ectopic parathyroid should be considered. We present two cases of patients which after hemithyroidectomy histopathological report, reported intrathyroid parathyroid adenoma. Intrathyroid parathyroid adenomas are an infrequent presentation of parathyroid adenomas that require high clinical suspicion if they are not detected by imaging studies in the preoperative period.

Robot-assisted complete thymectomy for mediastinal ectopic parathyroid adenomas in primary hyperparathyroidism

2016 ◽  
Vol 11 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Alison F. Ward ◽  
Timothy Lee ◽  
Jennifer B. Ogilvie ◽  
Kepal N. Patel ◽  
Karen Hiotis ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Robot Assisted ◽  
Parathyroid Adenomas ◽  
Ectopic Parathyroid

scholarly journals MON-123 Underdiagnosis of Primary Hyperparathyroidism in the Outpatient Setting of an Academic Health Care System

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nardeen Dawood ◽  
Dalena Nguyen ◽  
Chi-Hong Tseng ◽  
Masha Jean Livhits ◽  
Angela M Leung ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
International Workshop ◽  
Elevated Serum ◽  
Outpatient Setting ◽  
Total Calcium ◽  
Ipth Level ◽  
Serum Total Calcium ◽  
Tertiary Healthcare ◽  
Study Population ◽  
Repeat Assessment

Abstract Background: Primary hyperparathyroidism (PHPT) is the leading cause of hypercalcemia in the outpatient population and is associated with nephrolithiasis, osteoporosis, and further end-organ effects. When indicated, parathyroidectomy is an effective intervention. The aim of this study was to assess the prevalence of patients with hypercalcemia resulting from undiagnosed PHPT within a large, urban, academic healthcare system. Methods: The study population comprised all patients within UCLA Health. The electronic medical record was queried between 01/01/2016-12/31/2018 to include patients with at least two elevated serum total calcium concentrations (&gt;10.4 mg/dL) within a six-month period in the outpatient setting. Causes of secondary and tertiary PHPT were excluded. In concordance with the PHPT diagnostic criteria outlined by the Fourth International Workshop, we evaluated the proportion of patients with hypercalcemia who were further assessed with a serum intact parathyroid hormone (iPTH) test. The study identified cases of PHPT as defined by confirmed elevated serum total calcium concentrations and elevated or inappropriately normal iPTH concentrations. Results: There were 7102 patients with a single elevated serum total calcium result who never received a repeat assessment within the study period. Although there were 5617 patients with confirmed hypercalcemia, only 2773 (51%) had an iPTH level assessed within six months of the repeated calcium measurement. Of those who underwent iPTH testing, 1931 (69%) were biochemically confirmed to have classic (34.2%) or normohormonal (35.4%) PHPT; the remaining 31% had an appropriately suppressed iPTH concentration relative to the hypercalcemia. Conclusions: In a large, academic, tertiary healthcare center, over half of the ambulatory patients with confirmed hypercalcemia did not receive further work-up to assess for possible PHPT. Efforts to improve diagnosis of PHPT and expand curative treatment have the potential to decrease the prevalence of nephrolithiasis, bone loss, and further end-organ effects associated with the disease.

scholarly journals Mediastinal parathyroid adenomas and their surgical implications

2015 ◽  
Vol 97 (4) ◽  
pp. 259-261 ◽  
Author(s):  
Jesse Hu ◽  
KY Ngiam ◽  
R Parameswaran
Keyword(s):  
Primary Hyperparathyroidism ◽  
Minimally Invasive ◽  
Surgical Approach ◽  
Common Site ◽  
Common Cause ◽  
Parathyroid Adenomas ◽  
Persistent Hyperparathyroidism ◽  
Ectopic Parathyroid ◽  
Surgical Unit ◽  
Mediastinal Parathyroid

Primary hyperparathyroidism is a relatively common problem encountered by any endocrine surgical unit. Ectopic parathyroid adenomas have been known to be a common cause of persistent hyperparathyroidism after surgery. A common site of the missed ectopic gland will be that in the mediastinum. However, with the increasing improvement in available imaging, it is likely that this can be diagnosed preoperatively. The surgical approach to the mediastinal parathyroid has also changed vastly over the last decade from maximally invasive to minimally invasive with minimal complications. We provide a review on the entity of mediastinal parathyroid adenomas and their surgical implications.

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