Supernumerary parathyroid glands in hyperparathyroidism associated with multiple endocrine neoplasia type 1

d’Alessandro, André Fernandes; Montenegro, Fábio Luiz de Menezes; Brandão, Lenine Garcia; Lourenço, Delmar M.; Toledo, S. P. A.; Cordeiro, Anói Castro

doi:10.1590/s0104-42302012000300012

Cited by 11 publications

(5 citation statements)

References 22 publications

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“…A previous study reported that urolithiasis-related renal complications in MEN1-associated primary hyperparathyroidism were more frequent and progressive than sporadic complications ( 13 ). Supernumerary and/or ectopic parathyroid glands are common in MEN1 cases, as observed in the present case ( 14 ). In addition, total parathyroidectomy with autotransplantation or subtotal parathyroidectomy should be recommended in MEN1 cases ( 1 ).…”

Section: Discussionsupporting

confidence: 79%

Challenging Differential Diagnosis of Hypergastremia and Hyperglucagonemia with Chronic Renal Failure: Report of a Case with Multiple Endocrine Neoplasia Type 1

et al. 2017

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A 53-year-old woman developed end-stage renal failure during a 15-year clinical course of primary hyperparathyroidism and was referred to our hospital for evaluation of suspected multiple endocrine neoplasia type 1 (MEN1). Genetic testing revealed a novel deletion mutation at codon 467 in exon 10 of the MEN1 gene. Systemic and selective arterial calcium injection (SACI) testing revealed hyperglucagonemia and hypergastrinemia with positive gastrin responses. A pathological examination revealed glucagonoma and a lymph node gastrinoma. The findings in this case indicate the importance of early diagnosis of MEN1 and demonstrate the utility of systemic and SACI testing in renal failure cases.

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Section: Discussionsupporting

confidence: 79%

Challenging Differential Diagnosis of Hypergastremia and Hyperglucagonemia with Chronic Renal Failure: Report of a Case with Multiple Endocrine Neoplasia Type 1

et al. 2017

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“…It is important to note that HPT1 is frequently related to parathyroid hyperplasia and not adenoma in MEN1 patients and that accurate localization by preoperative imaging in this setting might be even more challenging. In addition, it is important to emphasize that the frequency of supernumerary parathyroid glands in HPT1 of MEN1 patients is significant and above 10% [20, 21].…”

Section: Discussionmentioning

confidence: 99%

¹⁸F‐fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism

et al. 2020

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Background Primary hyperparathyroidism (HPT1) is the most frequent endocrinopathy in multiple endocrine neoplasia type 1 (MEN1). Its surgical management is challenging. We aimed to describe and compare the imaging findings of parathyroid ultrasound (US), sestaMIBI scintigraphy (sestaMIBI), and 18F‐fluorocholine (FCH) PET/CT in a series of MEN1 patients with HPT1. Methods Retrospective analysis of a cohort of MEN1 patients with HPT1 assessed by parathyroid US, sestaMIBI scintigraphy and SPECT/CT, and FCH‐PET/CT for potential surgery between 2015 and 2019. Results Twenty‐two patients with a confirmed diagnosis of MEN1 who presented with HPT1 and were assessed by the 3 imaging modalities were included. After imaging workups, 11 patients were operated on for the first time, 4 underwent a redo surgery, and 7 did not undergo an operation. The overall patient‐based positivity rate of imaging was 91% (20 of 22) for parathyroid US and 96% (21 of 22) for both sestaMIBI and FCH‐PET/CT. The 3 imaging modalities demonstrated negative findings in 1/22 patient who did not undergo surgery. Overall, 3 pathologic glands were not detected by any imaging technique. SestaMIBI and FCH‐PET/CT both resulted in the same 3 false‐positive results in ectopic areas with a significant uptake on two thymic carcinoid tumors and one inflammatory lymph node. FCH‐PET/CT provided more surgically relevant data than sestaMIBI in 4/11 patients with initial surgery and in 1/4 patient who underwent redo surgery. Conclusions Compared to sestaMIBI scintigraphy, FCH‐PET/CT provides additional information regarding the number of pathologic parathyroid glands and their localization in MEN1 patients with HPT1.

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“…Although the prevalence of supernumerary glands in HPT patients with MEN1 is not as frequent as in patients with secondary HPT, it is not uncommon and has been reported as 12.2%. [ 35 ] The incidence of supernumerary HPT among sporadic primary HPTs is low, reported as 0.7%. [ 36 , 37 ]…”

Section: Causes Of Perhptmentioning

confidence: 99%

“…In primary HPT, approximately 60% of the supernumerary glands are located in the mediastinum, often in the thymus. [ 35 ] However, in series with neck reexploration for perHPT or recHPT, the ratio of supernumerary parathyroid glands is higher and varies between 7.4 and 39.5%. [ 38 - 40 ]…”

Section: Causes Of Perhptmentioning

confidence: 99%

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Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

Uludağ¹

2023

Sisli Etfal

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Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia and currently the only definitive treatment is surgery. Although the success rate of parathyroidectomy is over 95% in experienced centers, surgical failure is the most common complication today. Persistent HPT (perHPT) is defined as persistence of hypercalcemia after parathyroidectomy or recurrence of hypercalcemia within the first 6 months, and recurrence of hypercalcemia after a normocalcemic period of more than 6 months is defined as recurrent HPT (recHPT). In the literature, perHPT is reported to be 2–22%, and the rate of recHPT is 1–15%. perHPT is often associated with misdiagnosed pathology or inadequate resection of hyperfunctioning parathyroid tissue, recHPT is associated with newly developing pathology from potentially pathologically natural tissue left in situ at the initial surgery. In the pre-operative evaluation, the initial diagnosis of pHPT and the diagnosis of perHPT or rec HPT should be confirmed in patients who are evaluated with a pre-diagnosis (suspect) of perHPT and recHPT. Surgery is recommended if it meets any of the recommendations in surgical guidelines, as in patients with pHPT, and there are no surgical contraindications. The first preoperative localization studies, surgical notes, operation drawings, if any, intraoperative PTH results, pathological results, and post-operative biochemical results of these patients should be examined. Localization studies with preoperative imaging methods should be performed in all patients with perHPT and recHPT with a confirmed diagnosis and surgical indication. The first-stage imaging methods are ultrasonography and Tc99m sestamibi single photon tomography Tc99mMIBI SPECT or hybrid imaging method, which is combined with both single-photon emission computed tomography and computed tomography (SPECT/CT). The combination of USG and sestamibi scintigraphy increases the localization of the pathological gland. In the secondary stage, Four-Dimensional computer tomography (4D-CT) or dynamic 4-dimensional Magnetic Resonance Imaging (4D-MRI) can be applied. It is focused on as a secondary stage imaging method, especially when the lesion cannot be detected by conventional methods. Positron Emission Tomography (PET) and PET/CT examinations with 11C-choline or 18F-fluorocholine are promising imaging modalities. Invasive examinations can rarely be performed in patients in whom suspicious, incompatible or pathological lesion cannot be detected in noninvasive imaging methods. Bilateral jugular vein sampling, selective venous sampling, parathyroid arteriography, imaging-guided fine-needle aspiration biopsy, and parathormone washout are invasive methods.

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Supernumerary parathyroid glands in hyperparathyroidism associated with multiple endocrine neoplasia type 1

Cited by 11 publications

References 22 publications

Challenging Differential Diagnosis of Hypergastremia and Hyperglucagonemia with Chronic Renal Failure: Report of a Case with Multiple Endocrine Neoplasia Type 1

Challenging Differential Diagnosis of Hypergastremia and Hyperglucagonemia with Chronic Renal Failure: Report of a Case with Multiple Endocrine Neoplasia Type 1

¹⁸F‐fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

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Supernumerary parathyroid glands in hyperparathyroidism associated with multiple endocrine neoplasia type 1

Cited by 11 publications

References 22 publications

Challenging Differential Diagnosis of Hypergastremia and Hyperglucagonemia with Chronic Renal Failure: Report of a Case with Multiple Endocrine Neoplasia Type 1

Challenging Differential Diagnosis of Hypergastremia and Hyperglucagonemia with Chronic Renal Failure: Report of a Case with Multiple Endocrine Neoplasia Type 1

18F‐fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

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¹⁸F‐fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism