Tc<sup>99m</sup>-Sestamibi Uptake in Osteitis Fibrosa Cystica Simulating Metastatic Bone Disease

Rubin, Mishaela R.; LiVolsi, Virginia A.; Bandeira, Francisco; Caldas, Gustavo; Bilezikian, John P.

doi:10.1210/jcem.86.11.7994

Cited by 21 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, since 1994, when Joyce et al first reported that multiple brown tumors in primary hyperparathyroidism due to adenoma can mimic metastatic disease on MIBI scan [7], there have been many similar reports [8][9][10]. Thus, even in the presence of very high levels of Ca and intact PTH in the serum, urolithiasis and bone abnormalities with multiple destructive masses in the ribs on CT and MIBI and a palpable neck tumor, the presence of brown tumors should be considered as the differential diagnosis of metastasis of malignant parathyroid.…”

Section: Discussionmentioning

confidence: 99%

Multiple Brown Tumors in Primary Hyperparathyroidism Caused by an Adenoma Mimicking Metastatic Bone Disease with False Positive Results on Computed Tomography and Tc-99m Sestamibi Imaging: MR Findings

et al. 2007

View full text Add to dashboard Cite

Abstract. We encountered an unusual case of hyperparathyroidism with both hemosiderin deposits on the ribs and low intensity on T2-weighted magnetic resonance imaging (MRI) caused by a parathyroid adenoma with multiple brown tumors that mimicked metastatic bone tumor due to false positive results on computed tomography (CT) and Tc-99m sestamibi (MIBI) imaging. The patient, a middle-aged woman, had very high serum levels of calcium (14.1 mg/dl), alkaline phosphatase (9,369 IU/l) and intact-PTH (12,400 pg/ml), and a large tumor (2.5 cm in diameter) in the lower portion of the left lobe of the thyroid. Plain X-ray revealed a soft tumor in the left chest wall. On CT scan, there were multiple destructive masses in the ribs, including large intramedullary masses on both 3rd ribs. On MIBI scintigraphy, there was strong late uptake in the lower portion of the left cervical region, both 3rd ribs, and the left 7th, 8th, and 10th ribs. T2-weighted image MRI scans showed that both 3rd ribs had a low intensity with hemosiderin deposits. These findings suggested that the patient had hyperparathyroidism with multiple bone metastases due to carcinoma of the parathyroid gland. However, on pathology, the resected tumor of lower portion of the left lobe of thyroid was diagnosed as a parathyroid adenoma, and the tumors of the left 3rd and 7th ribs, as well as the right 2nd rib, were shown to be brown tumors. After resection, the patient's serum levels of calcium, alkaline phosphatase, and intact-PTH normalized. At 1.5-years follow-up, CT, MIBI, and MRI scans showed no abnormal findings. It is necessary to determine whether MRI can be used to distinguish between brown tumors and metastases caused by carcinoma of the parathyroid gland. THE most common cause of primary hyperparathyroidism is a solitary adenoma, followed by hyperplasia and carcinoma [1]. Conventional techniques for detecting the location of abnormal parathyroid glands are associated with many difficulties and often yield false negative and false positive results. Recently, Tc-99m hexakis methoxyisobutylisonitrile (MIBI) imaging was established as the best and most convenient localization method for detecting adenoma [1], after having been first reported by Coakley et al.

show abstract

Section: Discussionmentioning

confidence: 99%

Multiple Brown Tumors in Primary Hyperparathyroidism Caused by an Adenoma Mimicking Metastatic Bone Disease with False Positive Results on Computed Tomography and Tc-99m Sestamibi Imaging: MR Findings

et al. 2007

View full text Add to dashboard Cite

show abstract

“…A study performed in our institution showed that Sestamibi imaging may also detect brown tumors in severe PHPT (113). This abnormal uptake is still not well explained, but seems to be due to increased osteoclastic activity and perfusion of the lesion.…”

Section: Imaging Procedures and Localization Techniquesmentioning

confidence: 95%

“…This abnormal uptake is still not well explained, but seems to be due to increased osteoclastic activity and perfusion of the lesion. In the presence of metastatic disease the differential diagnosis between benign and malignant disease can be difficult (113).…”

Section: Imaging Procedures and Localization Techniquesmentioning

confidence: 99%

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

Bandeira

Griz

Chaves

et al. 2013

Arq Bras Endocrinol Metab

Self Cite

View full text Add to dashboard Cite

Objective: To conduct a literature review on the diagnosis and management of primary hyperparathyroidism including the classical hipercalcemic form as well as the normocalcemic variant. Materials and methods: This scientific statement was generated by a request from the Brazilian Medical Association (AMB) to the Brazilian Society for Endocrinology as part of its Clinical Practice Guidelines program. Articles were identified by searching in PubMed and Cochrane databases as well as abstracts presented at the Endocrine Society, Brazilian Society for Endocrinology Annual Meetings and the American Society for Bone and Mineral Research Annual Meeting during the last 5 years. Grading quality of evidence and strength of recommendation were adapted from the first report of the Oxford Centre for Evidence-based Medicine. All grades of recommendation, including "D" , are based on scientific evidence. The differences between A, B, C and D, are due exclusively to the methods employed in generating evidence. Conclusion:We present a scientific statement on primary hyperparathyroidism providing the level of evidence and the degree of recommendation regarding causes, clinical presentation as well as surgical and medical treatment. Arq Bras Endocrinol Metab. 2013;57(6):406-24 KeywordsPrimary hyperparathyroidism; normocalcemic primary hyperparathyroidism; diagnosis; treatment; parathyroidectomy ReSumoObjetivo: Conduzir uma atualização das últimas evidências científicas a respeito da apresentação, do diagnóstico e do manejo clínico e cirúrgico do hiperparatireoidismo primário clássico e normocalcêmico. Materiais e métodos: Este documento foi concebido pelo Departamento de Metabolismo Ósseo da Sociedade Brasileira de Endocrinologia e Metabologia (SBEM) a partir daquele oriundo do Programa de Diretrizes da Associação Médica Brasileira (AMB) da SBEM. Realizamos uma revisão dos artigos mais relevantes obtidos nos bancos de dados PubMed e Cochrane, além de abstracts apresentados nos encontros anuais da Endocrine Society, da Sociedade Brasileira de Endocrinologia e da American Society for Bone and Mineral Research dos últimos cinco anos, e classificamos as evidências em níveis de recomendações de acordo com a força científica por tipo de estudo, adaptando o primeiro relato do "Oxford Centre for Evidence-based Medicine" . Todos os graus de recomendação, incluindo-se o "D" , foram baseados em evidência científica, sendo as diferenças entre o A, B, C e D devidas exclusivamente ao desenho empregado na geração da evidência. Conclusão: Apresentamos uma atualização científica a respeito do hiperparatireoidismo primário, classificando e graduando em níveis de recomendações as principais evidências científicas sobre as suas causas, as variadas formas de apresentação, seu diagnóstico e tratamento. Arq Bras Endocrinol Metab. 2013;57(6):406-24 Descritores Hiperparatireoidismo primário; hiperparatireoidismo primário normocalcêmico; diagnóstico; tratamento; paratireoidectomia

show abstract

“…However Tc-99 sestamibi can also be taken up by skeletal brown tumors, mimicking metastatic parathyroid cancer. This may be due to increased perfusion, metabolism, and osteoclastic activity (23).…”

Section: Localization Procedures and Treatmentmentioning

confidence: 99%

From mild to severe primary hyperparathyroidism: the Brazilian experience

Bandeira

Griz

Caldas

et al. 2006

Arq Bras Endocrinol Metab

Self Cite

View full text Add to dashboard Cite

Primary hyperparathyroidism often presents as an asymptomatic disorder. In our institution, routine serum calcium measurements have now been used as part of medical examination for 23 years. Out of 124 patients consecutively seen at our institution, 47% presented with no symptoms related to the disease, while 25% presented with severe skeletal involvement and osteitis fibrosa cystica, 25% with renal stone disease without overt bone involvement, and 2% with the typical neuropsychiatric syndrome. This same pattern is seen in the city of São Paulo. In severe disease pathological fractures are frequently seen, especially in long bones of the lower extremities, and also loss of lamina dura of the teeth and salt-and-pepper appearance of the skull. Bone mineral density is extremely low in these patients but usually show remarkable recovery following surgical cure. Serum PTH and bone markers are considerable higher in severely affected patients, who also have a high rate of vitamin D deficiency, and the parathyroid lesion is easier located compared with asymptomatic patients. From pathological specimens 87% had histological confirmation of a single adenoma, 6.4% multiple gland hyperplasia and 3.8% carcinoma. Na maioria dos relatos da literatura recente, o hiperparatiroidismo primário apresenta-se, com freqüência, na forma assintomática. Em nossa instituição utilizamos a determinação rotineira do cálcio sérico há 23 anos. Em nossa série de 124 casos consecutivos, 45% não apresentavam sintomas relacionados com a doença, 25% tinham envolvimento esquelético intenso com osteíte fibrosa cística, 25% tinham nefrolitíase sem envolvimento ósseo severo, e 2% apresentavam a síndrome neuro-psiquiátrica típica. Esse mesmo padrão tem sido observado na cidade de São Paulo. Na doença severa são freqüentes as fraturas patológicas, especialmente nos ossos longos dos membros inferiores, como também a reabsorção da lâmi-na dura dos dentes e o aspecto em "sal e pimenta" nas radiografias do crânio. A densidade mineral óssea mostra-se extremamente reduzida nesses pacientes, mas em geral exibe melhora marcante após a cura cirúrgi-ca. O PTH no soro e os marcadores bioquímicos da remodelação óssea estão significativamente mais altos nos pacientes com doença severa, os quais freqüentemente apresentam deficiência de vitamina D e localização mais fácil da lesão paratiroideana, quando comparados aos pacientes assintomáticos. Ao exame anátomo-patológico, 87% tiveram confirmação de adenoma único, 6,4% hiperplasia glandular difusa e 3,8% carcinoma.

show abstract

Tc^99m-Sestamibi Uptake in Osteitis Fibrosa Cystica Simulating Metastatic Bone Disease

Cited by 21 publications

References 26 publications

Multiple Brown Tumors in Primary Hyperparathyroidism Caused by an Adenoma Mimicking Metastatic Bone Disease with False Positive Results on Computed Tomography and Tc-99m Sestamibi Imaging: MR Findings

Multiple Brown Tumors in Primary Hyperparathyroidism Caused by an Adenoma Mimicking Metastatic Bone Disease with False Positive Results on Computed Tomography and Tc-99m Sestamibi Imaging: MR Findings

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

From mild to severe primary hyperparathyroidism: the Brazilian experience

Contact Info

Product

Resources

About

Tc99m-Sestamibi Uptake in Osteitis Fibrosa Cystica Simulating Metastatic Bone Disease

Cited by 21 publications

References 26 publications

Multiple Brown Tumors in Primary Hyperparathyroidism Caused by an Adenoma Mimicking Metastatic Bone Disease with False Positive Results on Computed Tomography and Tc-99m Sestamibi Imaging: MR Findings

Multiple Brown Tumors in Primary Hyperparathyroidism Caused by an Adenoma Mimicking Metastatic Bone Disease with False Positive Results on Computed Tomography and Tc-99m Sestamibi Imaging: MR Findings

Diagnosis and management of primary hyperparathyroidism: a scientific statement from the Department of Bone Metabolism, the Brazilian Society for Endocrinology and Metabolism

From mild to severe primary hyperparathyroidism: the Brazilian experience

Contact Info

Product

Resources

About

Tc^99m-Sestamibi Uptake in Osteitis Fibrosa Cystica Simulating Metastatic Bone Disease