The Current Role of Parathyroid Fine-Needle Biopsy (P-FNAB) with iPTH-Washout Concentration (iPTH-WC) in Primary Hyperparathyroidism: A Single Center Experience and Literature Review

Introduction. Primary hyperparathyroidism (PHPT) is a condition characterized by disorders of calcium–phosphate metabolism and bone metabolism caused by pathological overproduction of parathyroid hormone (PTH). The diagnosis of overt PHPT is based on the presence of clinical symptoms and laboratory abnormalities typical of this condition: hypercalcemia, hypercalciuria and elevated iPTH levels. Imaging studies are not used for diagnostic purposes; they are performed to localize the parathyroid glands prior to potential surgical treatment. Technetium 99 m sestamibi scintigraphy (Tc99 m-MIBI) is the gold standard in the assessment of pathologically altered parathyroid glands. Other diagnostic options include cervical ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). Parathyroid biopsy (P-FNAB) with iPTH washout concentration (iPTH-WC) assessment is still an underestimated method of preoperative parathyroid gland localization. Few studies have reported the utility of US-guided P-FNAB in preoperative assessment of parathyroid lesions. The aim of the study was to present our experience with 143 P-FNAB with iPTH-WC assessment. Material and methods. Laboratory results, US findings, P-FNAB complications and comparison with other imaging techniques were described and analyzed. Results. In 133 (93.0) patients, iPTH washout-to-serum ratio exceeded threshold level 0.5 and were classified as positive results. Median iPTH-WC in this group was 16,856 pg/mL, and the iPTH-WC to serum iPTH ratio was 158. There was no correlation between iPTH-WC and serum PTH, serum calcium, parathyroid gland volume and shape index. In the group of 46 operated patients, 44 demonstrated positive iPTH-WC results, which corresponds to a sensitivity of 95.6%. In Tc99-MIBI, radiotracer retention was found in 17 cases (in 24 MIBI performed), which corresponds to a sensitivity of 52.2%. P-FNAB did not cause any major side effects −92.5% of all patients had no or mild adverse events after this procedure. Conclusions. P-FNAB with iPTH-WC is a reliable method in parathyroid adenoma localization during PHPT. Its sensitivity for diagnosis of PHPT is much higher than that of Tc99-MIBI, and in some situations, P-FNAB with iPTH-WC may even replace that method. Furthermore, cost-effectiveness of iPTH-WC is at least similar to that of Tc99-MIBI. Complications of P-FNAB are mild and we can describe this method as a safe procedure.

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Primary Hyperparathyroidism due to Parathyroid Adenoma Originated from Supernumerary Gland

Case Reports in Otolaryngology ◽

10.1155/2018/6482546 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Fernando Mendoza-Moreno ◽

Ángel Rodriguez-Pascual ◽

María Rocío Díez-Gago ◽

Marina Pérez-González ◽

Laura Jiménez‐Alvárez ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Adenoma ◽

Parathyroid Gland ◽

Imaging Techniques ◽

High Sensitivity ◽

Parathyroid Glands ◽

Parathyroid Surgery ◽

Thyroid Lobe ◽

The Impact ◽

Supernumerary Gland

Introduction. The variability of the location of the parathyroid glands is directly related to the events that occur during embryonic development. The impact that an individual submits more than four parathyroid glands is close to 13%. However the presentation of a parathyroid adenoma in a supernumerary gland is an uncommon event. Case report. A 30-year-old man diagnosed with primary hyperparathyroidism with matching findings on ultrasonography and scintigraphy for parathyroid adenoma localization lower left regarding the thyroid gland. A cervicotomy explorer showed four orthotopic parathyroid glands. The biopsy of the inferior left gland was normal. No signs of adenoma were seen in the biopsy. Following mobilization of the ipsilateral thyroid lobe, fifth parathyroid gland was found increased significantly in size than proceeded to remove, confirming the diagnosis of adenoma. After the excision, the levels of serum calcium and parathyroid hormone were normalized. Conclusions. The presentation of a parathyroid adenoma in a supernumerary gland is a challenge for the surgeon. The high sensitivity having different imaging techniques has been a key to locate preoperatively the pathological parathyroid gland. Analytical or clinical persistence of primary hyperparathyroidism after parathyroid surgery can occur if the location of the adenoma is a supernumerary or ectopic gland location.

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Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?

ISRN Surgery ◽

10.5402/2011/962186 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

S. Helme ◽

A. Lulsegged ◽

P. Sinha

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Gland ◽

Thyroid Surgery ◽

Parathyroid Tissue ◽

Neck Surgery ◽

Safe Procedure ◽

Preclinical Phase ◽

Abnormal Parathyroid Gland ◽

Parathyroid Disease ◽

History Of

Aim. Despite an incidence of parathyroid “incidentalomas” of 0.2%–4.5%, only approximately 135 cases have been reported in the literature. We present eight patients in whom an incidental abnormal parathyroid gland was found during routine thyroid surgery. We have reviewed the literature and postulate whether these glands could represent further evidence of a preclinical stage of primary hyperparathyroidism. Methods. A retrospective analysis of all 236 thyroid operations performed by a single surgeon was performed to identify patients in whom abnormal parathyroid tissue was removed at surgery. Results. 8/236 patients (3.39%) had a single macroscopically abnormal parathyroid gland removed and sent for analysis. Seven patients were found to have histological evidence of a parathyroid adenoma or hyperplasia. None of the patients had abnormal serum calcium detected preoperatively. Postoperatively, four patients had normal calcium, three had temporary hypocalcaemia and one refused followup. No patients had recurrent laryngeal nerve impairment. Conclusions. Despite the risk of removing a histologically normal gland, we believe that when parathyroid “incidentalomas” are found during surgery they should be excised and sent for histological analysis. We have found this to be a safe procedure with minimal morbidity to the patient. As the natural history of primary hyperparathyroidism is better understood, these glands found in normocalcaemic patients may in fact represent the early or preclinical phase of the disease. By removing them at the original operation, the patient is saved redo neck surgery with its high complication rate as or when clinically apparent primary hyperparthryoidism develops in the future.

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Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland - Case report and review

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302012000600009 ◽

2012 ◽

Vol 56 (6) ◽

pp. 393-403 ◽

Cited By ~ 8

Author(s):

Sofia Gouveia ◽

Dírcea Rodrigues ◽

Luísa Barros ◽

Cristina Ribeiro ◽

Anabela Albuquerque ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Gland ◽

Median Sternotomy ◽

Parathyroid Glands ◽

Aortopulmonary Window ◽

Genetic Syndromes ◽

Subtotal Parathyroidectomy ◽

Common Causes ◽

Ectopic Parathyroid ◽

99Mtc Sestamibi

Primary hyperparathyroidism (PHPT) is a common endocrine disorder that mainly affects middle-aged women. Patients are usually asymptomatic. The disease might be ascribable to hyperplasia, carcinoma, and single or multiple adenomas. PHPT may be sporadic or familial, the latter comprising multiple endocrine neoplasia type 1 or 2A, familial benign hypocalciuria hypercalcemia, and hyperparathyroidism-jaw tumor syndrome. The most common causes for persistent PHPT are multiglandular disease, and missed abnormal ectopic or orthotopic parathyroid glands. Imaging localization studies should precede a new surgical intervention. Ectopic parathyroid glands are rarely located at the aortopulmonary window. For diagnosis confirmation, 99mTc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform 99mTc-sestamibi followed by thoracic CT or MRI. Parathyroidectomy may be performed by means of median sternotomy, thoracotomy, or video-assisted thoracoscopy. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the aortopulmonary window. As the investigation necessary to clarify the etiology of recurrent nephrolithiasis proceeded, the diagnosis of PHPT was determined. The patient underwent subtotal parathyroidectomy; nevertheless, PHPT persisted. Genetic syndromes that could account for this condition were excluded. Imaging studies available at that time were not able to locate abnormal glands; moreover, the patient refused to undergo surgical exploration. Later, the patient underwent 99mTc-sestamibi SPECT/CT, which revealed a parathyroid gland at the aortopulmonary window.

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Distribution of the solitary adenoma over the parathyroid glands

The Journal of Laryngology & Otology ◽

10.1017/s0022215100137636 ◽

1997 ◽

Vol 111 (5) ◽

pp. 459-460 ◽

Cited By ~ 4

Author(s):

F. Debruyne ◽

F. Ostyn ◽

P. Delaere

Keyword(s):

Statistical Analysis ◽

Primary Hyperparathyroidism ◽

Parathyroid Gland ◽

Histological Examination ◽

Surgical Procedure ◽

Random Distribution ◽

Parathyroid Glands ◽

Solitary Adenoma

AbstractOne hundred and ten patients with primary hyperparathyroidism were studied, in which a normal parathyroid gland was found on the same side as an adenoma (both confirmed by histological examination), and the upper or lower location could clearly be defined during surgery. The distribution of the adenomas over the upper and lower glands was unequal: 61.8 per cent in the superior versus 38.2 per cent in the inferior position. Statistical analysis revealed that this is not a random distribution (p = 0.013). The explanation of this relative predilection is unknown. The finding should not influence the surgical procedure for primary hyperparathyroidism

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THE RELATION BETWEEN THE THYROID AND PARATHYROID GLANDS

Journal of Experimental Medicine ◽

10.1084/jem.24.5.547 ◽

1916 ◽

Vol 24 (5) ◽

pp. 547-559 ◽

Cited By ~ 12

Author(s):

Andreas Tanberg

Keyword(s):

Thyroid Gland ◽

Parathyroid Gland ◽

Clinical Symptoms ◽

Parathyroid Glands ◽

Indirect Interaction ◽

Thyroid Glands ◽

Meat Diet ◽

Two Systems

The following conclusions may be drawn from the experiments presented in this article. 1. Excessive meat diet develops hypertrophy of the thyroid gland. A definite hypertrophy of the parathyroid gland under the same conditions has not been established. A meat diet does not develop hypertrophy of the thyroid gland when insufficiency of the parathyroid gland exists at the same time, even if no clinical symptoms are present. Where a pronounced hypertrophy caused by a meat diet has already developed, the hypertrophy disappears and the gland assumes its ordinary appearance after extirpation of a sufficiently large number of parathyroid glands. 2. After parathyroidectomy no hypertrophy of the thyroid gland takes place. In chronic tetany the thyroid gland seems, on the contrary, to atrophy in spite of a meat diet. 3. After complete extirpation of the thyroid gland, the parathyroid gland does not change its structure, even in cases where the cachexia lasts for several years. Small remaining parts of the thyroid gland may through hypertrophy develop into compact tissue and thereby seemingly present some points of resemblance to the parathyroid gland. 4. When the parathyroid gland hypertrophies, as in some forms of chronic tetany, this hypertrophy is characterized by the development of large, transparent, sharply defined cells, with large nuclei rich in chromatin. 5. The parathyroid and thyroid glands are independent organs, each having specific functions. This, however, does not exclude the occurrence of a direct or indirect interaction in the functions of the two systems. 6. There is reason to believe that an insufficiency of the parathyroid gland checks to some extent the function of the thyroid gland. No proof of the existence of a vicarious cooperation between the two glands has been established.

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Parathyroid gland adenoma: Case report

Medicinski pregled ◽

10.2298/mpns0308377b ◽

2003 ◽

Vol 56 (7-8) ◽

pp. 377-380

Author(s):

Gradimir Bojkovic ◽

Zorica Caparevic ◽

Dragos Stojanovic ◽

Djordje Lalosevic ◽

Mirjana Stojanovic

Keyword(s):

Case Report ◽

Primary Hyperparathyroidism ◽

Parathyroid Gland ◽

Parathyroid Glands ◽

Simultaneous Occurrence ◽

Thyroid Adenoma ◽

Treatment Efficiency ◽

Laboratory Screening ◽

Partial Thyroidectomy ◽

Excessive Secretion

Introduction Primary hyperparathyroidism is a generalized disorder resulting from excessive secretion of parathyroid hormone involving one or more parathyroid glands. Both familial and sporadic forms exist. Histologic examination reveals parathyroid adenoma in about 90% of patients, although it is sometimes difficult to distinguish an adenoma from a normal gland. Primary hyperparathyroidism is commonly characterized by hypercalcaemia, hypophosphatemia and excessive bone resorption. Case report This is a case report of a 52-year old female patient with toxic thyroid adenoma and a parathyroid gland adenoma. The patient underwent partial thyroidectomy as a method of choice in treatment of toxic thyroid adenoma. Two years later, clinical hyperparathyroidism caused by an adenoma of parathyroid gland has manifested and was surgically removed. Discussion and conclusion In mild hypercalcaemia, many patients are asymptomatic and this condition is frequently discovered accidentally during routine laboratory screening. In order to provide operative treatment efficiency in thyroid nodule cases, besides thyroid gland morphological diagnostics, it is necessary to perform a preoperative verification of parathyroid glands as well. This diagnostic approach is essential in identifying possible simultaneous occurrence of multiple diseases, such as: thyroid and adenoma of parathyroid gland, in order to diminish incorrect diagnostic estimates.

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Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review

Endocrine Surgery ◽

10.14341/serg12241 ◽

2020 ◽

Vol 13 (4) ◽

pp. 153-174

Author(s):

Konstantin Y. Slashchuk ◽

Michail V. Degtyarev ◽

Pavel O. Rumyantsev ◽

Ekaterina A. Troshina ◽

Galina A. Melnichenko

Keyword(s):

Nuclear Medicine ◽

Literature Review ◽

Primary Hyperparathyroidism ◽

European Society ◽

Imaging Techniques ◽

Parathyroid Glands ◽

Preoperative Imaging ◽

Surgical Removal ◽

Medicine Physician

Primary hyperparathyroidism (PHPT) is a common endocrine disease that occurs with multiple profiles in which no classical manifestation. Diagnosis revolves around routine measurement of serum calcium and parathyroid hormone more than in half cases. The understanding of clinical presentation, epidemiology and management tactics of patients with hyperparathyroidism has significantly changed by virtue of the use of biochemical calcium screening. The successful diagnosis and treatment are possible with the cooperation of a multidisciplinary team of endocrinologist, endocrine surgeon, radiologist, nuclear medicine physician and pathomorphologist. The only radical method of treatment is the surgical removal of abnormal parathyroid glands. In this regard, there is necessary to improve the parathyroid glands imaging algorithms. Early treatment of hyperparathyroidism allows to avoid severe damage to the bones, kidneys, heart, other organs, improving the quality of life and reducing the incidence of disability. For a systematic literature review, more than 100 articles published from 2000 to the present time were used, on following resources: PubMed, Embase, SciSearch, Scopus, Cochrane Databases, Research Gate, Google Scholar. Including recommendations from the American Association of Endocrinologists and Endocrine Surgeons (AACE/AAES), European Society of Nuclear Medicine (EANM), European Society ofEndocrinologists (ESE), Russian Association of Endocrinologists (RAE) and several other organizations. The main goal of this review is to summarize and present relevant information and a new look on preoperative imaging techniques, methods of intraoperative navigation, surgery, control quality of treatment in patients with primary hyperparathyroidism.

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Parathyroids: The Forgotten Glands

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.19.1.9 ◽

2000 ◽

Vol 19 (1) ◽

pp. 9-16 ◽

Cited By ~ 3

Author(s):

Shari Steffensrud

Keyword(s):

Parathyroid Hormone ◽

Parathyroid Gland ◽

Calcium Homeostasis ◽

Clinical Symptoms ◽

Parathyroid Glands ◽

Calcium Balance ◽

Term Infants ◽

Common Problems

Symptomatic calcium disorders—most notably, hypocalcemia— are common problems in preterm and certain term infants. Many factors predispose susceptible neonates to hypo- or hypercalcemia, but in many cases, the root of the problem is altered function of the parathyroid glands. Parathyroid gland dysfunction may affect calcium homeostasis and alter physiologic functioning, resulting in significant clinical symptoms. A review of how the parathyroid glands and parathyroid hormone affect calcium balance and of the problems that result from altered function promotes a better appreciation of the important role played by these sometimes “forgotten” glands in maintaining normal neonatal physiologic functioning.

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Diagnostic Role and Therapeutic Perspectives of Endoscopic Ultrasound for Pancreatic Neuroendocrine Tumor

The Korean Journal of Pancreas and Biliary Tract ◽

10.15279/kpba.2021.26.1.1 ◽

2021 ◽

Vol 26 (1) ◽

pp. 1-9

Author(s):

Jun-Ho Choi

Keyword(s):

Neuroendocrine Tumor ◽

Endoscopic Ultrasound ◽

Imaging Techniques ◽

Preoperative Assessment ◽

Pancreatic Neuroendocrine Tumor ◽

Fine Needle Biopsy ◽

Effective Treatment Option ◽

Curative Surgery ◽

Ki 67 ◽

Cross Sectional

Pancreatic neuroendocrine tumors (PNETs) are rare tumors with malignant potential, but their incidence has appreciably increased over the last few decades. Diagnosis of PNETs is often difficult with conventional imaging methods. Cross-sectional imaging localizes less than 10% of PNETs less than 1 cm in diameter. Endoscopic ultrasound (EUS) has been shown to be superior to other imaging techniques in the preoperative localization and diagnosis of PNETs. The finding of a hyperenhanced lesion on contrastenhanced EUS was highly predictive of PNETs different from adenocarcinoma. Preoperative assessment of tumor differentiation and Ki-67 is an important prognostic factor for grading. Thus, EUS-guided fine needle biopsy may play a key role in the work-up of nonfunctioning PNETs, and attempts to measure Ki-67 on cytologic and histologic samples have been made. According to the European Neuroendocrine Tumor Society guidelines, there is no clear evidence of a survival benefit of surgery for nonfunctioning G1 PNETs <2 cm in diameter. The benefits of curative surgery must be weighed against operative morbidity and mortality. Although surgical resection remains the mainstay for PNETs, EUS-guided ablation offers a relatively safe and effective treatment option in patients deemed unfit for, or who do not want to undergo, surgery. EUS-guided ablation provides an attractive therapeutic nonsurgical option for patients; however, further studies that better elucidate the long-term outcomes with standardization of technique will help define its role in the treatment of PNETs. The role of EUS in the diagnosis and treatment of PNETs is expected to make much progress in the future.

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Primary hyperparathyroidism and vitamin D deficiency

Terapevticheskii arkhiv ◽

10.26442/00403660.2021.10.201081 ◽

2021 ◽

Vol 93 (10) ◽

pp. 1221-1226

Author(s):

Gyuzel E. Runova ◽

Olga O. Golounina ◽

Irina V. Glinkina ◽

Valentin V. Fadeev

Keyword(s):

Vitamin D ◽

Primary Hyperparathyroidism ◽

Vitamin D Deficiency ◽

Severe Disease ◽

Preoperative Assessment ◽

Vitamin D Insufficiency ◽

Parathyroid Glands ◽

Cellular Mechanisms ◽

Vitamin D Levels

Primary hyperparathyroidism (PHPT) is the third most common endocrine disease after diabetes mellitus and thyroid pathology. Recent epidemiological and experimental data have shown that long-term maintenance of low vitamin D levels in the blood can lead to the development of hyperplastic processes in the cells of the parathyroid glands, followed by autonomous production of parathyroid hormone. In PHPT vitamin D insufficiency or deficiency according to various sources occurs with a frequency of 5377% of cases. The literature review indicates more severe disease in patients with concomitant vitamin D deficiency. The expediency of preoperative assessment of vitamin D levels in all patients with PHPT in order to minimize the risk of hypocalcemia after parathyroidectomy is discussed. This article presents the relationship between vitamin D deficiency and PHPT, as well as possible methods for correcting vitamin D deficiency in PHPT. Molecular and cellular mechanisms of the occurrence of pathological processes in the parathyroid glands under conditions of low vitamin D levels are presented.

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