Advertisement

Ectopic Parathyroid Adenoma

  • Hakan Demir
Chapter

Abstract

Elevated serum calcium and parathyroid hormone (PTH) values were determined in routine laboratory examinations of a 66-year-old female patient. Parathyroid scintigraphy (PS) and neck ultrasonography (USG) were performed for diagnosis of primary hyperparathyroidism.

PS revealed an ectopic parathyroid gland in the mediastinum. Fused SPECT/CT images were generated from PS SPECT and CT images using the co-registration software. Exact localization of ectopic parathyroid adenoma could be performed by fused SPECT/CT images. With the help of gamma probe, a soft tissue mass 1 cm in size was excised from anterior mediastinum in mediastinoscopy. Histopathological examinations were consistent with parathyroid adenoma. The patient was discharged from hospital after dropping of serum calcium value to the normal level.

In conclusion preoperative localization of abnormal ectopic parathyroid gland was done easily and more precisely by PS SPECT/CT in this case. And also, using gamma probe in parathyroidectomy helped to surgeons to find ectopic parathyroid adenoma quickly and precisely.

Keywords

Primary hyperparathyroidism Parathyroid adenoma Scintigraphy Technetium-99m-sestamibi SPECT SPECT/CT Gamma probe Minimally invasive 

References

  1. 1.
    Dasgupta DJ, Navalkissoor S, Ganatra R, Buscombe J. The role of single-photon emission computed tomography/computed tomography in localizing parathyroid adenoma. Nucl Med Commun. 2013;34:621–6.CrossRefGoogle Scholar
  2. 2.
    Roy M, Mazeh H, Chen H, Sippel RS. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg. 2013;37:102–6.CrossRefGoogle Scholar
  3. 3.
    Smith JR, Oates ME. Radionuclide imaging of the parathyroid glands: patterns, pearls, and pitfalls. Radiographics. 2004;24:1101–15.CrossRefGoogle Scholar
  4. 4.
    Vestergaard P, Thomsen SV. Medical treatment of primary, secondary, and tertiary hyperparathyroidism. Curr Drug Saf. 2011;6:108–13.CrossRefGoogle Scholar
  5. 5.
    Campbell MJ. The definitive management of primary hyperparathyroidism: who needs an operation? JAMA. 2017;317:1167–8.CrossRefGoogle Scholar
  6. 6.
    Fraser WD. Hyperparathyroidism. Lancet. 2009;374:145–58.CrossRefGoogle Scholar
  7. 7.
    Wong KK, Fig LM, Gross MD, Dwamena BA. Parathyroid adenoma localization with 99mTc-sestamibi SPECT/CT: a meta-analysis. Nucl Med Commun. 2015;36:363–75.CrossRefGoogle Scholar
  8. 8.
    Desiato V, Melis M, Amato B, Bianco T, Rocca A, Amato M, et al. Minimally invasive radioguided parathyroid surgery: a literature review. Int J Surg. 2016;28(Suppl 1):S84–93.CrossRefGoogle Scholar
  9. 9.
    Rubello D, Casara D, Giannini S, Piotto A, De Carlo E, Muzzio PC, et al. Importance of radio-guided minimally invasive parathyroidectomy using hand-held gamma probe and low (99m)Tc-MIBI dose. Technical considerations and long-term clinical results. Q J Nucl Med. 2003;47:129–38.PubMedGoogle Scholar
  10. 10.
    Ikeda Y, Takayama J, Takami H. Minimally invasive radioguided parathyroidectomy for hyperparathyroidism. Ann Nucl Med. 2010;24:233–40.CrossRefGoogle Scholar
  11. 11.
    Coakley AJ, Kettle AG, Wells CP, O’Doherty MJ, Collins RE. 99Tcm sestamibi—a new agent for parathyroid imaging. Nucl Med Commun. 1989;10:791–4.CrossRefGoogle Scholar
  12. 12.
    Treglia G, Trimboli P, Huellner M, Giovanella L. Imaging in primary hyperparathyroidism: focus on the evidence-based diagnostic performance of different methods. Minerva Endocrinol. 2017.  https://doi.org/10.23736/S0391-1977.17.02685-2.
  13. 13.
    Geatti O, Shapiro B, Orsolon PG, Proto G, Guerra UP, Antonucci F, et al. Localization of parathyroid enlargement: experience with technetium-99m methoxyisobutylisonitrile and thallium-201 scintigraphy, ultrasonography and computed tomography. Eur J Nucl Med. 1994;21:17–22.CrossRefGoogle Scholar
  14. 14.
    Hindié E, Ugur O, Fuster D, O'Doherty M, Grassetto G, Ureña P, et al. Parathyroid task group of the EANM. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009;36:1201–16.CrossRefGoogle Scholar
  15. 15.
    Greenspan BS, Dillehay G, Intenzo C, Lavely WC, O'Doherty M, Palestro CJ, et al. SNM practice guideline for parathyroid scintigraphy 4.0. J Nucl Med Technol. 2012;40:111–8.CrossRefGoogle Scholar
  16. 16.
    Serra A, Bolasco P, Satta L, Nicolosi A, Uccheddu A, Piga M. Role of SPECT/CT in the preoperative assessment of hyperparathyroid patients. Radiol Med. 2006;111:999–1008.CrossRefGoogle Scholar
  17. 17.
    Setabutr D, Vakharia K, Nogan SJ, Kamel GN, Allen T, Saunders BD, et al. Comparison of SPECT/CT and planar MIBI in terms of operating time and cost in the surgical management of primary hyperparathyroidism. Ear Nose Throat J. 2015;94:448–52.PubMedGoogle Scholar
  18. 18.
    Papathanassiou D, Flament JB, Pochart JM, Patey M, Marty H, Liehn JC, et al. SPECT/CT in localization of parathyroid adenoma or hyperplasia in patients with previous neck surgery. Clin Nucl Med. 2008;33:394–7.CrossRefGoogle Scholar
  19. 19.
    Gayed IW, Kim EE, Broussard WF, Evans D, Lee J, Broemeling LD, et al. The value of 99mTc-sestamibi SPECT/CT over conventional SPECT in the evaluation of parathyroid adenomas or hyperplasia. J Nucl Med. 2005;46:248–52.PubMedGoogle Scholar
  20. 20.
    Treglia G, Sadeghi R, Schalin-Jäntti C, Caldarella C, Ceriani L, Giovanella L, et al. Detection rate of (99m) Tc-MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: a meta-analysis. Head Neck. 2016;38(Suppl 1):E2159–72.CrossRefGoogle Scholar
  21. 21.
    Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med. 2007;48:1084–9.CrossRefGoogle Scholar
  22. 22.
    Tardelli E, Mazzarri S, Rubello D, Gennaro M, Fantechi L, Duce V, et al. Sentinel lymph node biopsy in cutaneous melanoma: standard and new technical procedures and clinical advances. A systematic review of the literature. Clin Nucl Med. 2016;41:498–507.CrossRefGoogle Scholar
  23. 23.
    Manca G, Tardelli E, Rubello D, Gennaro M, Marzola MC, Cook GJ, et al. Sentinel lymph node biopsy in breast cancer: a technical and clinical appraisal. Nucl Med Commun. 2016;37(6):570.CrossRefGoogle Scholar
  24. 24.
    Bonjer HJ, Bruining HA, Pols HA, de Herder WW, van Eijck CH, Breeman WA, et al. Intraoperative nuclear guidance in benign hyperparathyroidism and parathyroid cancer. Eur J Nucl Med. 1997;24:246–51.PubMedGoogle Scholar
  25. 25.
    Mehrabibahar M, Mousavi Z, Sadeghi R, Layegh P, Nouri M, Asadi M. Feasibility and safety of minimally invasive radioguided parathyroidectomy using very low intraoperative dose of Tc-99m MIBI. Int J Surg. 2017;39:229–33.CrossRefGoogle Scholar
  26. 26.
    Onoda N, Ishikawa T, Nishiyama N, Kawabe J, Takashima T, Hirakawa K. Focused approach to ectopic mediastinal parathyroid surgery assisted by radio-guided navigation. Surg Today. 2014;44:533–9.CrossRefGoogle Scholar
  27. 27.
    Rubello D, Kapse N, Grassetto G, Massaro A, Al-Nahhas A. Minimally invasive radio-guided surgery for primary hyperparathyroidism: from preoperative to intraoperative localization imaging. Ann Endocrinol (Paris). 2010;71:511–8.CrossRefGoogle Scholar
  28. 28.
    Minamiya Y, Saito H, Ito M, Motoyama S, Katayose Y, Ogawa J. Radio-guided thoracoscopic surgery with (99m)Tc-methoxy-isobutylisonitrile for treating an ectopic mediastinal parathyroid adenoma in an adolescent girl. Gen Thorac Cardiovasc Surg. 2009;57:657–9.CrossRefGoogle Scholar
  29. 29.
    García-Talavera P, González-Selma ML, Ruiz M, Gamazo C, Sainz-Esteban A, Villanueva JG, Olmos R. The value of early SPECT/CT and hand-held γ-camera in radio-guided surgery: a case of a hard-to-locate parathyroid adenoma. Clin Nucl Med. 2014;39:1009–11.CrossRefGoogle Scholar
  30. 30.
    Jorna FH, Jager PL, Lemstra C, Wiggers T, Stegeman CA, Plukker JT. Utility of an intraoperative gamma probe in the surgical management of secondary or tertiary hyperparathyroidism. Am J Surg. 2008;196:13–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Hakan Demir
    • 1
  1. 1.Department of Nuclear Medicine, School of MedicineKocaeli UniversityKocaeliTurkey

Personalised recommendations