scholarly journals Long standing hypercalcemia in a 78-years old woman

2021 ◽  
Author(s):  
Andreas Kiriakopoulos ◽  
Dimitrios Linos
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Memory Loss ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Imaging Studies ◽  
The Past

A 78 years-old woman was found with worsening hypercalcemia, osteopenia and memory loss during the past 2 years. Multiple, repeated imaging studies failed to reveal the aetiology of the primary hyperparathyroidism. Bilateral neck exploration revealed a 4.5X2,3 cm right superior parathyroid adenoma in an ectopic position.

scholarly journals Correlation of perioperative biochemical variables with single adenoma weight in patients with primary hyperparathyroidism

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marios Papadakis ◽  
Norbert Weyerbrock ◽  
Hubert Zirngibl ◽  
Cornelia Dotzenrath
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Serum Calcium ◽  
Bilateral Neck Exploration ◽  
University Hospital ◽  
Neck Exploration ◽  
Single Adenoma ◽  
Preoperative Serum ◽  
Intraoperative Pth ◽  
The Relationship

Abstract Background Single parathyroid adenoma is the main cause of primary hyperparathyroidism (PHPT), with surgery remaining the gold standard for its treatment. The ability to preoperatively predict the parathyroid adenoma size and could facilitate the decision about the extent of surgical exploration. It is reasonable to hypothesize that the perioperative levels of PHPT-related variables (i.e. calcium, parathormone, phosphate) may predict the adenoma weight or/and demonstrate whether the adenoma is successfully removed or not. Aim of this study is to explore the relationship between perioperative biochemical values and adenoma weight. Secondarily, we investigated the relationship between adenoma weight and uni-/bilateral neck exploration. Methods Retrospective study of all patients undergone surgery for primary hyperparathyroidism due to single adenoma in a tertiary university hospital in Germany during a 6-year period. Following variables were analyzed: preoperative serum calcium, phosphorus and parathormone, intraoperative parathormone before and after adenoma excision, intraoperative PTH decrease, postoperative serum calcium and parathormone (PTHpostop—pg/ml), calcium and PTH decrease. Bivariate correlations were calculated by the Spearman's correlation test at the 95% significance level. Results A total of 339 patients were included in the study. The median age of the patients was 60 years (range 21–90) and 77% were females. The median adenoma weight was 1 g (range 0.1–11). Adenoma weight correlated strong with maximum adenoma diameter (r = 0.72, p < 0.05), moderate with preoperative parathormone (r = 0.44) and parathormone decrease (r = 0.27), whereas there was no correlation with the intraoperative PTH decrease (r = 0.02). There was also a borderline (moderate to weak) correlation with pre- and postoperative calcium levels (r = 0.21 and r = 0.23 respectively) and a negative borderline correlation with phosphorus (r = − 0.21). Patients who required bilateral neck exploration, had significantly lighter adenomas (median weight 0.8 g vs 1.1 g, p = 0.005). Conclusions We conclude that preoperative PTH levels may only serve as an approximate guide to adenoma weight, as direct preoperative prediction is not possible. Serum calcium levels, PTH and calcium decrease correlate only weak with adenoma weight. Patients who require bilateral neck exploration, have significantly (20–25%) lighter adenomas.

Ambulatory bilateral neck exploration for primary hyperparathyroidism: is it safe?

2016 ◽  
Vol 212 (4) ◽  
pp. 722-727 ◽  
Author(s):  
Colleen M. Kiernan ◽  
Cameron Schlegel ◽  
Chelsea Isom ◽  
Sandra Kavalukas ◽  
Mary F. Peters ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Neck Exploration

Ambulatory bilateral neck exploration for primary hyperparathyroidism: Is it safe?

2017 ◽  
Vol 213 (6) ◽  
pp. 1191-1192
Author(s):  
Chandan Kumar Jha ◽  
Raouef Ahmed Bichoo ◽  
Sanjay Kumar Yadav ◽  
Chaitra Sonthineni ◽  
Sapana Bothra
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Neck Exploration

scholarly journals Single Center Experience in the Surgical Management of Primary Hyperparathyroidism

2020 ◽  
Vol 13 (3) ◽  
pp. 285-290
Author(s):  
Berat Demir ◽  
Adem Binnetoglu ◽  
Akın Sahin ◽  
Dilek Gogas Yavuz
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Imaging Modalities ◽  
Neck Exploration ◽  
Preoperative Imaging ◽  
Emission Computed Tomography ◽  
Laboratory Values ◽  
Ectopic Parathyroid ◽  
Pathology Reports

Objectives. As calcium included as a part of routine laboratory screening early diagnosis of primary hyperparathyroidism (PHPT) has been increased. Surgical resection of parathyroid adenoma or hyperplasia still is the mainstay of the treatment for most PHPT patients. The aim of this study was to evaluate of the surgical outcomes of patients with PHPT that referred to our ENT department of our University Hospital for the last 6 years.Methods. One hundred thirty-seven patients with PHPT who underwent parathyroid surgery in our clinic between October 2011 and January 2018 included in this retrospective study. Data on demographics, clinical findings, past medical history, preoperative laboratory values in 3 months, preoperative localizing imaging studies including ultrasonography (USG) and 99mTc-sestamibi (methoxyisobutyl isonitrile, [MIBI]) scan, operative findings, postoperative laboratory values, and pathology reports were recorded. MIBI scan and USG are used as the first-line modalities in our center. Single-photon emission computed tomography was used for challenging situations of re-exploration and ectopic parathyroid pathology. Four-dimensional computed tomography scanning is was preferred as the last imaging modality. Focused unilateral neck exploration (FUNE) was performed with intraoperative frozen section analysis as a routine procedure. Bilateral neck exploration (BNE) was used only in re-exploration, ectopic parathyroid, and with high suspicion of multigland disease.Results. Totally 137 patients (female:male, 3:3; mean age, 54.6±13.2 years) included in the study. Single parathyroid adenoma was found in 108 patients (78.8%). Most common adenoma localization was left inferior parathyroid gland (46.7%). FUNE was performed in 89.8% of the patients and BNE for 10.2% of the patients. Postoperative normocalcemia was reached in 132 patients and permanent hypocalcemia was observed in two patients. Persistence hypercalcemia observed in three patients. Postoperative pathology reports revealed three patients have parathyroid carcinoma.Conclusion. Preoperative imaging modalities is very important in parathyroidectomy surgery. Routine use of preoperative imaging modalities reduced the risk of complications in our clinic.

Increasing trend of bilateral neck exploration in primary hyperparathyroidism

2020 ◽  
Vol 219 (3) ◽  
pp. 466-470 ◽  
Author(s):  
Amna M. Khokar ◽  
Kristine M. Kuchta ◽  
Tricia A. Moo-Young ◽  
David J. Winchester ◽  
Richard A. Prinz
Keyword(s):  
Primary Hyperparathyroidism ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Increasing Trend

An Unusual Cause of Hot Spot on Parathyroid Imaging

2016 ◽  
Vol 8 (2) ◽  
pp. 164-167
Author(s):  
Reyaz M Singaporewalla ◽  
Anuradha Negi ◽  
Dominique YB Seow ◽  
Dinesh Chinchure
Keyword(s):  
Primary Hyperparathyroidism ◽  
False Positive ◽  
Single Photon ◽  
Hot Spot ◽  
Photon Emission ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Uneventful Recovery ◽  
Sestamibi Scan ◽  
Parathyroid Imaging

ABSTRACT Background and aim Radiological imaging is routinely used in patients with primary hyperparathyroidism to localize the abnormal adenoma and to plan surgical approach. We report an unusual cause of false-positive localization on parathyroid sestamibi scan, i.e., not previously described in the literature. Case report A 66-year-old man with primary hyperparathyroidism showed a discrete persistent focus in the left infraclavicular area during localization using sestamibi scan. Ultrasound of the neck was negative showing only small bilateral thyroid nodules. Single-photon emission and four-dimensional computed tomography (CT) scans showed an intense focus of the tracer uptake and a 1-cm lesion near the left subclavian vein (SCV), corresponding to the infraclavicular hot spot. Initial infraclavicular exploration showed the lesion to be a collapsible saccular varix of the left SCV. Bilateral neck exploration led to the discovery of the actual right parathyroid adenoma beneath an exophytic thyroid nodule. The patient made an uneventful recovery and remains normocalcemic at 1-year follow up. Conclusion and clinical significance Hot spot on parathyroid imaging outside the line of embryological descent should be interpreted with caution. Vascular retention of injected isotope within a saccular varix of the neck vein can give rise to falsepositive results on sestamibi scans. Bilateral neck exploration remains the “gold standard” procedure when localization scans either are negative or turn out to have false-positive findings. How to cite this article Singaporewalla RM, Negi A, Seow DYB, Chinchure D. An Unusual Cause of Hot Spot on Parathyroid Imaging. World J Endoc Surg 2016;8(2):164-167.

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