Success of Reoperative Neck Surgery in Persistent Hyperparathyroidism
Sustained normocalcemia throughout postoperative 6 months is considered as a complete recovery achieved by surgery. Parathyroid hormone (PTH) and calcium levels not being reduced or becoming higher again during 6 months after the surgery are defined as persistent hyperparathyroidism, whereas hypercalcemia and high levels of PTH more than 6 months later are defined as recurrent hyperparathyroidism. The most common cause of persistent HPT is multiglandular disorder and ectopic adenomas. Persistent HPT occurs as a result of an insufficient surgery. The most critical factor that lowers the rate of HPT is surgical experience. In this article, we presented a case of 36-year-old woman with persistent hypercalcemia following an unsuccessful operation due to failure of localization of her parathyroid adenoma by conventional imaging modalities and became normocalcemic only after an operation guided by an 18F-choline PET/CT imaging spotting the adenoma in the mediastinum.
KeywordsPersistent hyperparathyroidism 18F-choline PET MIBI Ectopic parathyroid adenoma Hyperparathyroidism
The authors would like to thank Assoc. Prof. Dr. Sait Sager for providing us with 18F-fluorocholine PET/CT image (Fig. 76.1) from the archive of Cerrahpasa School of Medicine, Department of Nuclear Medicine, İstanbul, Turkey.
- 2.Holt EH, Inzucchi SE. Physiology, and pathophysiology of the parathyroid glands and preoperative evaluation. In: Oertli D, Udelsman R, editors. Surgery of the thyroid and parathyroid glands. Heidelberg: Springer; 2008. p. 235–43.Google Scholar
- 3.Åkerström G, Juhlin C. Reoperation in primary hyperparathyroidism. In: Åkerström G, editor. Current controversy in parathyroid operation and reoperation. Austin: RG Landes Co.; 1994. p. 131–65.Google Scholar
- 4.Bilezikian JP, Khan AA, Potts JT Jr, Third International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement of the Third International Workshop. J Clin Endocrinol Metab. 2009;94:335–9. https://doi.org/10.1210/jc.2008-1763.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Udelsman R, Aruny JE, Donovan PI, Sokoll LJ, Santos F, Donabedian R, et al. Rapid parathyroid hormone analysis during venous localization. Ann Surg. 2003;237:714–21. https://doi.org/10.1097/01.SLA.0000064363.21261.36.CrossRefPubMedPubMedCentralGoogle Scholar