|
1
|
Morris MA, Saboury B, Ahlman M, Malayeri AA, Jones EC, Chen CC, Millo C. Parathyroid Imaging: Past, Present, and Future. Front Endocrinol (Lausanne) 2022; 12:760419. [PMID: 35283807 PMCID: PMC8914059 DOI: 10.3389/fendo.2021.760419] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/21/2021] [Indexed: 12/30/2022] Open
Abstract
The goal of parathyroid imaging is to identify all sources of excess parathyroid hormone secretion pre-operatively. A variety of imaging approaches have been evaluated and utilized over the years for this purpose. Ultrasound relies solely on structural features and is without radiation, however is limited to superficial evaluation. 4DCT and 4DMRI provide enhancement characteristics in addition to structural features and dynamic enhancement has been investigated as a way to better distinguish parathyroid from adjacent structures. It is important to recognize that 4DCT provides valuable information however results in much higher radiation dose to the thyroid gland than the other available examinations, and therefore the optimal number of phases is an area of controversy. Single-photon scintigraphy with 99mTc-Sestamibi, or dual tracer 99mTc-pertechnetate and 99mTc-sestamibi with or without SPECT or SPECT/CT is part of the standard of care in many centers with availability and expertise in nuclear medicine. This molecular imaging approach detects cellular physiology such as mitochondria content found in parathyroid adenomas. Combining structural imaging such as CT or MRI with molecular imaging in a hybrid approach allows the ability to obtain robust structural and functional information in one examination. Hybrid PET/CT is widely available and provides improved imaging and quantification over SPECT or SPECT/CT. Emerging PET imaging techniques, such as 18F-Fluorocholine, have the exciting potential to reinvent parathyroid imaging. PET/MRI may be particularly well suited to parathyroid imaging, where available, because of the ability to perform dynamic contrast-enhanced imaging and co-registered 18F-Fluorocholine PET imaging simultaneously with low radiation dose to the thyroid. A targeted agent specific for a parathyroid tissue biomarker remains to be identified.
Collapse
Affiliation(s)
| | | | | | | | | | - Clara C. Chen
- National Institutes of Health (NIH) Clinical Center, Department of Radiology and Imaging Sciences, Bethesda, MD, United States
| | - Corina Millo
- National Institutes of Health (NIH) Clinical Center, Department of Radiology and Imaging Sciences, Bethesda, MD, United States
| |
Collapse
|
|
2
|
Kumar A, Damle NA, Khandelwal D, Aggarwal V. Large Mediastinal Parathyroid Adenoma Presenting with Acute Pancreatitis. Indian J Endocrinol Metab 2020; 24:288-289. [PMID: 33083273 PMCID: PMC7539036 DOI: 10.4103/ijem.ijem_160_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Aman Kumar
- Department of Medicine, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, India
| | - Nishikant Avinash Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences (AIIMS), Punjabi Bagh, New Delhi, India
| | - Deepak Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, India
| | - Vivek Aggarwal
- Department of Endocrine Surgery, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, India
| |
Collapse
|
|
3
|
Jiajue R, Song A, Wang O, Li W. Persistent Hypercalcemia Crisis and Recurrent Acute Pancreatitis Due to Multiple Ectopic Parathyroid Carcinomas: Case Report and Literature Review of Mediastinal Parathyroid Carcinoma. Front Endocrinol (Lausanne) 2020; 11:647. [PMID: 33013712 PMCID: PMC7511513 DOI: 10.3389/fendo.2020.00647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/07/2020] [Indexed: 11/13/2022] Open
Abstract
Mediastinal parathyroid carcinoma (PC) is a rare entity in primary hyperparathyroidism. The aim of this report is to demonstrate a case of mediastinal PC, and to provide a systemic literature review of this rare condition. A 34-year-old woman who had already undergone two cervical operations for hyperparathyroidism suffered from another recurrence, presenting with recurrent acute pancreatitis and persistent hypercalcemic crisis. Technetium-99 methoxyisobutylisonitrile imaging (MIBI) and computed tomography scanning (CT) identified three possible parathyroid tumors, one of which was the recurrence of residual tumor locating in the thyroid region, while the other two were ectopic tumors locating in the suprasternal fossa and thymus region, respectively. Pathological examination confirmed the diagnosis of PC. We conducted a systemic literature review by searching the PubMed MEDLINE from 1951 to 2019 for studies of all types in the English language only, using terms "mediastinal, mediastinum, parathyroid, carcinoma." Including our reported case, a total of 21 cases with ectopic mediastinal PCs were assessed for demographic data, tumor location and size, biochemical findings, and symptomatology, etc. Two thirds of the patients were men, with a mean age of 44 years old, a mean serum calcium of 14.2 mg/dl, and a mean serum intact parathyroid hormone of 1,216 pg/ml. We identified 89.5% of carcinomas in the anterosuperior mediastinum, and 10.5% in the middle mediastinum, with a mean diameter of 54 mm, and a mean weight of 216 g. MIBI and CT were the most commonly used methods to localize these mediastinal tumors, with 69.2 and 100% sensitivity, respectively. Half of the patients underwent more than one operation. Diagnosis and treatment of mediastinal PCs represent a challenge. Early suspicion, appropriate preoperative localization studies, and the cooperation of endocrinologists and surgeons are crucial in the effective management.
Collapse
|
|
4
|
Ma YB, Hu J, Duan YF. Acute pancreatitis connected with hypercalcemia crisis in hyperparathyroidism: A case report. World J Clin Cases 2019; 7:2367-2373. [PMID: 31531333 PMCID: PMC6718780 DOI: 10.12998/wjcc.v7.i16.2367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The association between primary hyperparathyroidism (PHPT) and acute pancreatitis is rarely reported. Here we describe the process of acute pancreatitis-mediated PHPT induced by hypercalcemia in a male patient. Hypercalcemia induced by undiagnosed PHPT may be the causative factor in recurrent acute pancreatitis.
CASE SUMMARY We report a case of hypercalcemia-induced acute pancreatitis caused by a functioning parathyroid adenoma in a 57-year-old man. The patient initially experienced a series of continuous gastrointestinal symptoms including abdominal distension, abdominal pain, nausea, vomiting, electrolyte disturbance, renal dysfunction, and acute pancreatitis. Due to prolonged hypercalcemia, the patient subsequently underwent surgical resection of the parathyroid adenoma. Two weeks after surgery, his serum calcium, amylase, and lipase concentrations were normal. The patient had a good recovery after a series of other relevant therapies.
CONCLUSION Acute pancreatitis as the first presentation is a rare clinical symptom caused by PHPT-induced hypercalcemia.
Collapse
Affiliation(s)
- Yi-Bo Ma
- Department of B-mode Ultrasound, The First People’s Hospital of Changzhou, Changzhou 213003, Jiangsu Province, China
| | - Jun Hu
- Department of Hepatobiliary Surgery, The First People’s Hospital of Changzhou, Changzhou 213003, Jiangsu Province, China
| | - Yun-Fei Duan
- Department of Hepatobiliary Surgery, The First People’s Hospital of Changzhou, Changzhou 213003, Jiangsu Province, China
| |
Collapse
|
|
5
|
Cadena-Piñeros E, De Los Reyes CA, Llamas-Olier A, Romero-Rojas AE. Advantages of the 99mTc-sestamibi Single-Photon Emission Computed Tomography/Computed Tomography in Occult Parathyroid Adenoma and Concomitant Thyroid Papillary Carcinoma. Indian J Nucl Med 2019; 34:150-152. [PMID: 31040530 PMCID: PMC6481205 DOI: 10.4103/ijnm.ijnm_28_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hyperparathyroidism and concurrent thyroid nodular disease are prominent. In contrast, concomitant papillary thyroid cancer and hyperparathyroidism are uncommon (1%–2%). Parathyroid adenomas in unusual locations are difficult to detect by conventional diagnostic imaging. 99mTc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has increased the localizing success rate of these lesions since it provides specific functional and anatomical information, improving exploratory parathyroid surgery planning and decreasing operative time, unnecessary dissections, complications, and morbidity. We confirmed its usefulness in a patient with an occult parathyroid adenoma that was clearly identified by 99mTc-sestamibi SPECT/CT 2 weeks after a thyroidectomy for papillary carcinoma. The SPECT/CT results allowed us to successfully perform efficient reexploration of the thyroid bed, in a retroesophageal parathyroid adenoma by minimally invasive surgery.
Collapse
Affiliation(s)
- Enrique Cadena-Piñeros
- Department of Otorhinolaryngology and Head and Neck, Clínica de Marly, Colombia.,Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá D.C., Colombia.,Department of Head and Neck, Instituto Nacional de Cancerología, , Bogotá D.C., Colombia
| | | | - Augusto Llamas-Olier
- Department of Nuclear Medicine, Instituto Nacional de Cancerología, Bogotá D.C, Colombia
| | | |
Collapse
|
|
6
|
Şahin E, Elboğa U, Yetişyiğit T, Kalender E. Mediastinal Ectopic Parathyroid Adenoma in a Patient Followed for Colon Cancer and Chronic Renal Failure: A Challenging Case. J Med Imaging Radiat Sci 2014; 45:335-338. [DOI: 10.1016/j.jmir.2014.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/24/2014] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
|
|
7
|
Daliakopoulos SI, Chatzoulis G, Lampridis S, Pantelidou V, Zografos O, Ioannidis K, Sapranidis M, Ploumis A. Gamma probe-assisted excision of an ectopic parathyroid adenoma located within the thymus: case report and review of the literature. J Cardiothorac Surg 2014; 9:62. [PMID: 24685256 PMCID: PMC4230425 DOI: 10.1186/1749-8090-9-62] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/20/2014] [Indexed: 11/27/2022] Open
Abstract
Primary hyperparathyroidism due to parathyroid adenomas may be associated with ectopic parathyroid gland localization in 20-25% of the patients. We report herein the excision of an ectopic parathyroid adenoma which was detected in the thymus gland by gamma probe intraoperatively. A 38-year-old patient presented to our clinic with a history of bilateral nephrolithiasis, chronic hypercalcaemia, and PTH elevation. A combination of Technetium-99 m sestamibi scintigraphy and Computed Tomography scan of the chest and neck revealed an ectopic parathyroid adenoma of 8.5 mm in its greatest dimension. The patient underwent sternotomy and the adenoma was found within the right lobe of the thymus gland with the intraoperative use of gamma probe. PTH detection and frozen biopsy were performed during surgery and confirmed the successful excision of the adenoma, while mild hypocalcaemia was noticed postoperatively. We conclude that accurate preoperative and intraoperative localization of an ectopic parathyroid adenoma is crucial to successful surgery. The use of at least two diagnostic modalities before surgical excision minimizes the risk of re-operation for recurrent hyperparathyroidism, while the intraoperative use of gamma probe offers a significant advantage over conventional techniques by reducing surgical time, morbidity and/or complications associated with surgical exploration.
Collapse
Affiliation(s)
- Stavros I Daliakopoulos
- Department of Thoracic Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - George Chatzoulis
- Department of Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Savvas Lampridis
- Department of Thoracic Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Varvara Pantelidou
- Department of Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Omiros Zografos
- Department of Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Konstantinos Ioannidis
- Department of Surgery, 424 General Military Hospital, Eukarpia Ring Road, Thessaloniki Gr 564 29, Greece
| | - Michael Sapranidis
- Department of Endocrinology, Hippokration Hospital, Konstantinoupoleos 49, Thessaloniki Gr 546 42, Greece
| | - Avraam Ploumis
- Department of Orthopaedic Surgery and Rehabilitation, University Hospital of Ioannina, Stavrou Niarchou Avenue, Ioannina Gr 45 500, Greece
| |
Collapse
|
|
8
|
Mészáros L, Kajdácsi Z, Tóth M, Révai T, Vadász P. [Mediastinal parathyroid adenoma: a surgically treated case]. Magy Seb 2013; 66:191-193. [PMID: 23955953 DOI: 10.1556/maseb.66.2013.4.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sixteen percent of primary hyperparathyroidism is caused by ectopic parathyroid glands. These cases present diagnostic and therapeutic challenges. In this article we present the case of a patient underwent surgery for a mediastinal parathyroid adenoma causing symptomatic hypercalcaemia.
Collapse
Affiliation(s)
- László Mészáros
- Országos Korányi Tbc és Pulmonológiai Intézet, Semmelweis Egyetem Mellkassebészeti Tanszéki Csoport 1121 Budapest Pihenő út 1
| | | | | | | | | |
Collapse
|
|
9
|
Urata T, Yamasaki A, Sasaki A, Tonaki G, Iwasaki H, Minami N, Yoshioka R, Kitada H, Takekuma Y. Acute pancreatitis caused by an ectopic mediastinal parathyroid adenoma. Clin J Gastroenterol 2012; 5:393-7. [DOI: 10.1007/s12328-012-0338-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/19/2012] [Indexed: 12/11/2022]
|
|
10
|
Abboud B, Daher R, Boujaoude J. Digestive manifestations of parathyroid disorders. World J Gastroenterol 2011; 17:4063-4066. [PMID: 22039319 PMCID: PMC3203356 DOI: 10.3748/wjg.v17.i36.4063] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/25/2011] [Accepted: 04/02/2011] [Indexed: 02/06/2023] Open
Abstract
The parathyroid glands are the main regulator of plasma calcium and have a direct influence on the digestive tract. Parathyroid disturbances often result in unknown long-standing symptoms. The main manifestation of hypoparathyroidism is steatorrhea due to a deficit in exocrine pancreas secretion. The association with celiac sprue may contribute to malabsorption. Hyperparathyroidism causes smooth-muscle atony, with upper and lower gastrointestinal symptoms such as nausea, heartburn and constipation. Hyperparathyroidism and peptic ulcer were strongly linked before the advent of proton pump inhibitors. Nowadays, this association remains likely only in the particular context of multiple endocrine neoplasia type 1/Zollinger-Ellison syndrome. In contrast to chronic pancreatitis, acute pancreatitis due to primary hyperparathyroidism is one of the most studied topics. The causative effect of high calcium level is confirmed and the distinction from secondary hyperparathyroidism is mandatory. The digestive manifestations of parathyroid malfunction are often overlooked and serum calcium level must be included in the routine workup for abdominal symptoms.
Collapse
|
|
11
|
Tardin L, Prats E, Andrés A, Razola P, Deus J, Gastaminza R, Santapau A, Parra A, Banzo J. [Ectopic parathyroid adenoma: Scintigraphic detection and radioguided surgery]. ACTA ACUST UNITED AC 2011; 30:19-23. [PMID: 21208692 DOI: 10.1016/j.remn.2010.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 09/23/2010] [Accepted: 09/27/2010] [Indexed: 01/02/2023]
Abstract
AIM The aim of this study was to evaluate the role of (99m)Tc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas. METHODS We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function. RESULTS Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up. CONCLUSIONS Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up.
Collapse
Affiliation(s)
- L Tardin
- Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
12
|
Lenz JI, Jacobs JM, Op de Beeck B, Huyghe IA, Pelckmans PA, Moreels TG. Acute necrotizing pancreatitis as first manifestation of primary hyperparathyroidism. World J Gastroenterol 2010; 16:2959-62. [PMID: 20556845 PMCID: PMC2887595 DOI: 10.3748/wjg.v16.i23.2959] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma. Initially the acute pancreatitis was treated conservatively. The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst. Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity, it is very uncommon. The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known, although some mechanisms have been proposed. It is important to treat the provoking factor. Therefore, the cause of hypercalcemia should be identified early. Surgical resection of the parathyroid adenoma is the ultimate therapy.
Collapse
|
|
13
|
Yeşilkaya E, Cinaz P, Bideci A, Camurdan O, Demirel F, Demircan S. Hungry bone syndrome after parathyroidectomy caused by an ectopic parathyroid adenoma. J Bone Miner Metab 2009; 27:101-4. [PMID: 19057842 DOI: 10.1007/s00774-008-0010-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 04/22/2008] [Indexed: 10/21/2022]
Abstract
Hungry bone syndrome (HBS), i.e., persistent hypocalcemia and hypophosphatemia as a result of extensive remineralization, is rarely encountered in children after parathyroid surgery. Herein, we report a 12-year-old girl who was diagnosed to have an ectopic parathyroid adenoma, and HBS was observed in the postsurgical follow-up. The diagnosis and the risk factors are discussed in the light of the literature.
Collapse
Affiliation(s)
- Ediz Yeşilkaya
- Department of Pediatric Endocrinology, Gazi University Medical School, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
|
14
|
Cascales PA, Ríos A, Rodríguez JM, Parrilla P. [Severe acute pancreatitis presenting as an adenoma-induced hyperparathyroidism]. Cir Esp 2008; 83:274-5. [PMID: 18448038 DOI: 10.1016/s0009-739x(08)70573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Pedro A Cascales
- Unidad de Cirugía Endocrina, Servicio de Cirugía General y Aparato Digestivo I, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | | | | | | |
Collapse
|
|
15
|
Gurrado A, Marzullo A, Lissidini G, Lippolis A, Rubini D, Lastilla G, Testini M. Substernal oxyphil parathyroid adenoma producing PTHrP with hypercalcemia and normal PTH level. World J Surg Oncol 2008; 6:24. [PMID: 18291038 PMCID: PMC2279131 DOI: 10.1186/1477-7819-6-24] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2007] [Accepted: 02/21/2008] [Indexed: 11/13/2022] Open
Abstract
Background Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Preoperative serum calcium and intact-parathyroid hormone levels are the most useful diagnostic parameters that allow differentiating primary hyperparathyroidism from non-parathyroid-dependent hypercalcemia. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Approximately 5% of patients who underwent parathyroidectomy present with persistent or recurrent hyperparathyroidism due to ectopic localization of the adenoma. Functioning oxyphil parathyroid adenoma is an uncommon histological form, seldom causing primary hyperparathyroidism. Parathyroid adenoma with hypercalcemia exhibiting normal parathyroid hormone level is rare. An incidence of 5% to 33% has been documented in the literature; no etiologic explanation has been given. In 1987, parathyroid-hormone-related peptide was isolated as a causative factor of humeral hypercalcemia of malignancy. The presence of parathyroid-hormone-related peptide in parathyroid tissue under normal and pathological conditions has been described in the literature; however, its role in causing hyperparathyroidism has not yet been defined. Case presentation We present a case of persistent hypercalcemia with a normal level of intact-parathyroid hormone due to a substernal parathyroid adenoma, treated with radioguided parathyroidectomy. The final histological diagnosis was oxyphil adenoma, positive for parathyroid-hormone-related peptide antigens. Conclusion In clinical practice, this atypical biochemical presentation of primary hyperparathyroidism should be considered in the differential diagnosis of hypercalcemia. The parathyroid-hormone-related peptide should be considered not only in the presence of malignancy.
Collapse
Affiliation(s)
- Angela Gurrado
- Department of Applications in Surgery of Innovative Technologies, University Medical School of Bari,
| | | | | | | | | | | | | |
Collapse
|
|
16
|
Prats E, Razola P, Tardín L, Andrés A, García López F, Abós MD, Banzo J. Gammagrafía de paratiroides y cirugía radiodirigida en el hiperparatiroidismo primario. ACTA ACUST UNITED AC 2007; 26:310-28. [PMID: 17910844 DOI: 10.1157/13109149] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- E Prats
- Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | | | | | | | | | | | | |
Collapse
|
|
17
|
Bal A, Sachdeva MUS, Joshi K, Behera A, Arora S, Gupta S. Non-functioning mediastinal parathyroid adenoma with sarcoid-like granulomatous lymphadenopathy. APMIS 2007; 115:784-8. [PMID: 17550391 DOI: 10.1111/j.1600-0463.2007.apm_596.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Non-secretory parathyroid adenomas arising in an ectopic parathyroid gland are rare. We report a case of non-functioning anterior mediastinal parathyroid adenoma associated with mediastinal lymphadenopathy caused by sarcoid-like granulamatous inflammation.
Collapse
Affiliation(s)
- Amanjit Bal
- Department of Histopathology, Post Graduate Insititute of Medical Sciences & Research, Chandigarh, India.
| | | | | | | | | | | |
Collapse
|
|
18
|
Abouzahir A, Baite A, Azennag M, Bouchama R, Nzouba L. Pancréatite chronique calcifiante révélant une hyperparathyroïdie primaire. Rev Med Interne 2006; 27:640-2. [PMID: 16806594 DOI: 10.1016/j.revmed.2006.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Accepted: 03/30/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The association of pancreatitis and hyperparathyroidism is rare. CASE RECORD A 41-year-old man had consulted for a strong abdominal pain reliant to a chronic calcifying pancreatitis. A major hypercalcaemia led to a primary hyperparathyroidism diagnosis. The evolution was favourable after parathyroid adenoma surgery. DISCUSSION The hypercalcaemia activate the transformation of trypsinogen into trypsin which is toxic for the pancreas. The role of parathyroid hormone remains unclear.
Collapse
Affiliation(s)
- A Abouzahir
- Service de médecine interne, 5e hôpital militaire, BP 1052, 81000 Guelmim, Maroc.
| | | | | | | | | |
Collapse
|