Imaging of Parathyroid Glands

Chien, David; Jacene, Heather A.

doi:10.1016/j.otc.2010.01.008

Cited by 26 publications

(32 citation statements)

References 76 publications

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“…So-called "tertiary hyperparathyroidism" occurs when compensatory mechanisms result in autonomous function. Surgical extirpation of hyperfunctioning gland(s) is the treatment for primary hyperparathyroidism and for tertiary hyperparathyroidism when medical treatment fails (216).…”

Section: Parathyroid and Thyroid Scintigraphy With Spect/ctmentioning

confidence: 99%

Endocrine Scintigraphy with Hybrid SPECT/CT

et al. 2014

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Nuclear medicine imaging of endocrine disorders takes advantage of unique cellular properties of endocrine organs and tissues that can be depicted by targeted radiopharmaceuticals. Detailed functional maps of biodistributions of radiopharmaceutical uptake can be displayed in three-dimensional tomographic formats, using single photon emission computed tomography (CT) that can now be directly combined with simultaneously acquired cross-sectional anatomic maps derived from CT. The integration of function depicted by scintigraphy and anatomy with CT has synergistically improved the efficacy of nuclear medicine imaging across a broad spectrum of clinical applications, which include some of the oldest imaging studies of endocrine dysfunction.

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Section: Parathyroid and Thyroid Scintigraphy With Spect/ctmentioning

confidence: 99%

Endocrine Scintigraphy with Hybrid SPECT/CT

et al. 2014

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“…US had the advantage of being cheaper, not exposing the patient to ionize radiation and it can be easily performed in the clinical setting. 93 A recent risk adjusted analysis confirms that the addition of ultrasonography to scintigraphy based imaging test has an incremental value in localizing parathyroid adenoma and in decreasing the extent of surgery during parathyroidec- tomy. 94 It can be easily performed at the surgical table pre operatively by endocrine surgeon to direct the surgical incision prior of the exploration: parathyroid can appear typically from round to oval, homogeneous and hypoechoic compared with the thyroid gland and thyroid nodule: moreover parathyroid adenomas are often hypervascular at the Doppler flow.…”

Section: Ultrasonographymentioning

confidence: 95%

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Percivale

Gnerre²,

Damonte³

et al. 2015

Ital J Med

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Primary hyperparathyroidism (PHPT) is a disease caused by overactive secretion of parathyroid hormone (PTH) with a concurrent alteration of the phosphocalcemic metabolism: commonly we found an association between hypercalcemic status and elevated PTH plasma levels or not properly normal. Widespread screening of serum calcium introduced in the 70's has made PHPT a relatively common disease: in these cases hypercalcemia is quickly diagnosed and in the western world the disease tends to appear with not specific symptoms such as fatigue mood disturbance and cognitive impairments.1 The main cause is represented by a solitary parathyroid adenoma (80-85% of cases) (Figure 1): the remaining 15-20% of cases are represented by conditions of diffuse glandular hyperplasia ( Figure 2) and multiple adenomas. A small percentage of patients presents with typical familial forms of multiple endocrine neoplasia type 1 (MEN 1) and multiple endocrine neoplasia type 2 (MEN 2) syndromes.2,3 Primary hyperparathyroidism generally occurs with higher rate in a population older than 55 years: it occurs 2-3 times more frequently in women than in men and has a higher prevalence in postmenopausal women. Approximately 80% of patients with PHPT are asymptomatic being the asymptomatic hypercalcemic form the most representative: signs and symptoms, when present, are due to prolonged hypercalcemic status than to elevate serum levels of PTH. 4,5 The clinical manifestation remains variable ranging from the normocalcemic to the hypercalcemic PHPT form. 6,7 Methods of research ABSTRACTPrimary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role.

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“…The first line of pre-operative imaging techniques currently used to locate parathyroid adenomas include neck ultrasound and dual-phase 99m Tc-Sestamibi scintigraphy. A wide range of sensitivities (51 to 78%) and specificities (67 to 96%) have been reported for the ability of ultrasound to localize parathyroid adenomas (14,15). However, the use of ultrasound is limited to detecting adenomas located in the cervical region.…”

mentioning

confidence: 99%

“…Activity tends to wash out more slowly from parathyroid adenomas than from thyroid tissue, which consequently become more conspicuous on delayed imaging. Sensitivity of 99m Tc-Sestamibi parathyroid scintigraphy for detecting and localizing parathyroid adenomas ranges from 54 to 96%, while specificity ranges from 83 to 99% (14,15,17). In addition to planar imaging, single-photon emission computed tomography in combination with computed tomography has been reported to have a higher sensitivity (96%) (2) and a lower false-negative rate in detecting parathyroid adenomas, particularly ectopic adenomas, compared to conventional planar imaging.…”

mentioning

confidence: 99%

“…Newer scintigraphic techniques with reported superior ability to visualize ectopic parathyroid adenomas include imaging of 11 C-methionine using positron-emission tomography coupled with computed tomography or positron-emission tomography coupled with magnetic resonance imaging (15,20); these may be potential secondline imaging modalities in the event of a negative 99m TcSestamibi scan. The need for a cyclotron to produce the 11 C and limited availability of positron-emission tomography coupled with magnetic resonance imaging cameras limits these techniques to major research centers.…”

mentioning

confidence: 99%

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Hypercalcemic Crisis Secondary to A Parathyroid Hormone-Secreting, Intrathymic, Cystic, Parathyroid Adenoma

Diab

Awad

Purgina

et al. 2018

AACE Clinical Case Reports

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Objective: To report a rare case of a male patient with primary hyperparathyroidism due to a parathyroid hormone (PTH)-secreting, intrathymic, cystic, parathyroid adenoma.Methods: The pertinent clinical features, laboratory data, radiologic and pathologic findings are reported, along with a brief literature review.Results: A 69-year-old male was followed for asymptomatic hypercalcemia secondary to primary hyperparathyroidism since 2013. He was also incidentally found to have an anterior mediastinal mass on a chest X-ray which remained stable on annual follow-up. He was monitored regularly with serial calcium and renal function tests, with no indication for surgical intervention. Dual-phase 99m TcSestamibi scan did not localize a culprit parathyroid gland in the neck or upper chest. He presented in 2015 with renal failure and hypovolemic shock secondary to severe hypercalcemia (calcium 17.20 mg/dL, PTH 3,452 pg/mL) requiring intensive care unit admission. Treatment with aggressive hydration, diuresis and pamidronate failed to lower calcium levels. Patient underwent emergent surgical exploration with combined resection of 2 enlarged, eutopic parathyroid glands suspicious for adenoma and the cystic mediastinal mass. PTH levels from fluid within the cystic mediastinal mass were elevated at 1,290,000 pg/mL. Immediate postoperative PTH and calcium levels dropped to 58 pg/mL and 10.80 mg/dL, respectively. Pathology of the mediastinal mass was consistent with ectopic, intrathymic, parathyroid adenoma.Conclusion: Anterior mediastinal mass in the setting of hypercalcemia should be considered as a possible source of ectopic PTH production in the setting of an otherwise negative 99m Tc-Sestamibi parathyroid scan. Definitive treatment by resection of the mass is potentially curative.

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Imaging of Parathyroid Glands

Cited by 26 publications

References 76 publications

Endocrine Scintigraphy with Hybrid SPECT/CT

Endocrine Scintigraphy with Hybrid SPECT/CT

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Hypercalcemic Crisis Secondary to A Parathyroid Hormone-Secreting, Intrathymic, Cystic, Parathyroid Adenoma

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