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Radiology Case Reports Aug 2024An 18-year-old male with multiple endocrine neoplasm type 1 (MEN1) syndrome presented with hyperparathyroidism. Parathyroidectomy was performed. Patient complained of...
An 18-year-old male with multiple endocrine neoplasm type 1 (MEN1) syndrome presented with hyperparathyroidism. Parathyroidectomy was performed. Patient complained of bone pain afterwards, multiple imaging modalities revealed features of osteitis fibrosa cystica and biochemical profile showed features of hungry bone syndrome. Incidental suspicious pancreatic lesion was initially revealed by F-FDG PET/CT scan while MRI further characterized the possibility of insulinoma. Ultimately, the patient was diagnosed of MEN1 syndrome by genetic test. This case report demonstrates the utilization of various imaging modalities such as ultrasound, Tc-sestamibi parathyroid scintigraphy, bone scintigraphy, CT, PET/CT and MRI, which leads to ultimately the diagnosis of MEN1 syndrome.
PubMed: 38737174
DOI: 10.1016/j.radcr.2024.04.024 -
International Journal of Surgery Case... Jun 2024Maxillomandibular involvement with brown tumours is rare, especially in the paediatric population. We present a rare case of a young girl with brown tumour (BT)...
INTRODUCTION AND IMPORTANCE
Maxillomandibular involvement with brown tumours is rare, especially in the paediatric population. We present a rare case of a young girl with brown tumour (BT) occurring in the mandible as the first manifestation of hyperparathyroidism.
CASE PRESENTATION
A 7-year-old black female, presented with a 6-month history of a swelling on the left mandible. Patient had a history of intractable gastrointestinal symptoms such as nausea, vomiting and abdominal cramps. Biopsy confirmed the lesion as a giant cell lesion. Elevated parathyroid hormone (PTH) levels confirmed the diagnosis of a BT of hyperparathyroidism. The patient underwent surgical intervention involving parathyroidectomy. This was followed by segmental resection of the mandibular tumour two years later.
CLINICAL DISCUSSION
Brown Tumour is a rare, non-neoplastic lesion resulting from abnormal bone metabolism secondary to hyperparathyroidism. BT predominantly arise in long bones and the axial skeleton. Maxillomandibular involvement is very rare. In the present case, after parathyroidectomy, normal PTH and calcium levels were restored, and there was relief of gastrointestinal tract hypercalcaemic symptoms. However, there was no spontaneous regression of the mandibular tumour over a 2-year observation period. Hemimandibulectomy followed by reconstruction with a plate and costochondral graft was then performed.
CONCLUSION
It is difficult to differentiate BT from other giant cell lesions without blood chemistry revealing hyperparathyroidism. The distinction is imperative to avoid mutilating and aggressive treatment for BTs. Although BTs are amenable for conservative treatment, the present case illustrates that for bigger tumours, in the absence of spontaneous regression, aggressive surgical treatment may be required.
PubMed: 38735218
DOI: 10.1016/j.ijscr.2024.109735 -
American Journal of Surgery Apr 2024This is the first study of Canadian thyroid and parathyroid surgery legal decisions, and the first study of surgical malpractice using the Canadian Legal Information...
BACKGROUND
This is the first study of Canadian thyroid and parathyroid surgery legal decisions, and the first study of surgical malpractice using the Canadian Legal Information Institute (CanLII) database. The objective was to identify quality improvement opportunities in surgical practice, to increase patient safety and satisfaction.
METHODS
Legal decisions relating to thyroid and parathyroid surgery in the CanLII database were screened. Cases were included if a surgeon was listed as applicant or respondent; they related to pre-, intra-, or post-operative management of thyroid or parathyroid disease; and malpractice was alleged. Cases were excluded if surgery was mentioned incidentally or for non-surgical focus.
RESULTS
Of the 347 unique legal decisions screened, 14 met inclusion and exclusion criteria. Surgeries occurred between 1976 and 2012, with 13 thyroid surgeries, 1 parathyroidectomy, and 4 mortalities.
CONCLUSIONS
Quality improvement lessons include communication, pre-operative patient education and documentation of risks discussed, and in-person assessment of complications.
PubMed: 38734539
DOI: 10.1016/j.amjsurg.2024.04.018 -
Cureus Apr 2024Primary hyperparathyroidism (PHPT) is an extremely uncommon cause of cerebral calcification. A male patient, aged 45, was admitted to the neurosurgery clinic with a...
Primary hyperparathyroidism (PHPT) is an extremely uncommon cause of cerebral calcification. A male patient, aged 45, was admitted to the neurosurgery clinic with a closed traumatic brain injury, namely a concussion, resulting in symptoms of headache and loss of balance. A CT scan was conducted, which detected bilateral calcifications on the basal ganglia and the tentorium. The blood tests revealed increased levels of serum calcium, phosphate, and parathyroid hormone (PTH), while vitamin D levels were within the normal range. The patient received symptomatic therapy for the cerebral concussion and was referred for further diagnostic procedures. Based on these exams, it was determined that the patient had a parathyroid adenoma, which was responsible for PHPT characterised by increased levels of calcium, phosphate, and PTH. The patient subsequently underwent a successful parathyroidectomy. Half a year following the surgical procedure, the patient remained free of any indications of neurological conditions, and the levels of PTH and calcium in their body were within the expected range. Whenever trying to identify the cause of cerebral calcification, it is important to explore several possible diagnoses. A possible cause that should be taken into account is PHTP.
PubMed: 38721190
DOI: 10.7759/cureus.57826 -
Endocrine, Metabolic & Immune Disorders... May 2024Primary Hyperparathyroidism (PHPT) is a common disease, frequently diagnosed in post-menopausal women, among whom Osteoporosis (OP) is a common finding. To date, no...
OBJECTIVE
Primary Hyperparathyroidism (PHPT) is a common disease, frequently diagnosed in post-menopausal women, among whom Osteoporosis (OP) is a common finding. To date, no study has specifically evaluated the asymptomatic PHPT (aPHPT) patients without OP, in particular post-menopausal women who are exposed to an increased risk of developing OP.
DESIGN
This study involved a retrospective cross-sectional evaluation.
PATIENTS
From our database of 500 consecutive patients diagnosed with PHPT, 178 postmenopausal aPHPT were retrieved.
RESULTS
The clinical, biochemical, and imaging data of the 85 patients without OP were not different from those of the 93 with OP, except for bone alkaline phosphatase (significantly higher in the latter group). Among these 85 patients without OP, the 45 patients meeting surgical criteria for parathyroidectomy had significantly higher values of serum PTH (240 vs. 99 ng/L, p =0.03) and calcium (total, 11.2 ± 0.7 vs. 10.6 ± 0.4 mg/dL, p <0.001; ionized, 1.45 ± 0.12 vs. 1.36 ± 0.8 mmol/L, p =0.044) and lower values of serum phosphate (2.57 ± 0.7 vs. 2.94 ± 0.5 mg/dL, p =0.009) and eGFR (68.5 ± 23.8 vs 80.8 ± 14.4 mL/min/1.73 m2, p =0.006) than the 40 aPHPT patients not meeting surgical criteria, without any difference in densitometric data and calculated fracture risk.
CONCLUSION
In our series, post-menopausal aPHPT patients without OP accounted for almost a sixth of the whole PHPT series. About half of these patients did not meet surgical criteria, but their T scores and 10-year fracture risk calculated by FRAX were not significantly different from post-menopausal aPHPT without OP meeting surgical criteria.
PubMed: 38715334
DOI: 10.2174/0118715303288678240424074110 -
The British Journal of Surgery May 2024
Topics: Humans; Parathyroid Neoplasms; Consensus; Parathyroidectomy; Europe
PubMed: 38713608
DOI: 10.1093/bjs/znae108 -
The British Journal of Surgery May 2024Intraoperative parathyroid hormone (PTH) monitoring is a proven and reliable adjunct to parathyroid surgery, able to improve the outcomes and efficiency of the...
BACKGROUND
Intraoperative parathyroid hormone (PTH) monitoring is a proven and reliable adjunct to parathyroid surgery, able to improve the outcomes and efficiency of the diagnostic and therapeutic pathway for patients with primary hyperparathyroidism. This study evaluated the innovative, compact, fully automated NBCL CONNECT Analyzer, which can measure whole-blood PTH in 5 min.
METHODS
A prospective multicentre study was conducted in stages: results reviews, recommendations, and implementation of improvements to the mechanical design, components of cartridges, calibration, and sampling protocols. Patients undergoing parathyroidectomy had PTH levels measured on the Analyzer and main laboratory platforms, either Roche or Abbott. The Miami criterion of a 50% drop in PTH concentration was used to define biochemical cure during surgery, and normal postoperative calcium level as cure of primary hyperparathyroidism. Measurements on the Analyzer were done by laboratory staff in London and nurses in Stuttgart. The Pearson coefficient (R) and Wilcoxon test were used for statistical analysis.
RESULTS
Some 234 patients (55 male, 179 female) with a median age of 58.5 (age full range 15-88) years underwent parathyroidectomy (195 minimally invasive, 38 bilateral neck exploration, 1 thoracoscopic; 12 conversions) for primary hyperparathyroidism between November 2021 and July 2022. Primary hyperparathyroidism was cured in 225 patients (96.2%). The sensitivity, specificity, and overall accuracy of the Analyzer assay in predicting biochemical cure were 83.9, 100, and 84.8% in phase 1; 91.2, 100, and 91.3% in phase 2; and 98.6, 100, and 98.6% in phase 3. There were no false-positive results (positive predictive value 100%). Correlations between Analyzer measurements and those obtained using the Roche device were very strong (R = 0.98, P < 0.001 in phase 1; R = 0.92, P < 0.001 in phase 2; R = 0.94, P < 0.001 in phase 3), and correlations for Analyzer readings versus those from the Abbott platform were strong (R = 0.82, P < 0.001; R = 0.89, P < 0.001; R = 0.91, P < 0.001). The Analyzer showed continued good mechanical performance, with stable and repeatable operations (calibrations, quality controls). Introducing a stricter sampling protocol and improvements in the clot-detecting system led to a decrease in the number of clotted samples and false-negative results. Outcomes were not affected by measurements performed either by nurses or laboratory staff.
CONCLUSION
Intraoperative PTH monitoring during parathyroid surgery can be done accurately, simply, and quickly in whole blood using the Analyzer.
Topics: Humans; Middle Aged; Female; Parathyroid Hormone; Male; Prospective Studies; Parathyroidectomy; Adult; Aged; Monitoring, Intraoperative; Adolescent; Aged, 80 and over; Hyperparathyroidism, Primary; Young Adult
PubMed: 38713606
DOI: 10.1093/bjs/znae101 -
Endokrynologia Polska May 2024Not required for Clinical Vignette.
Not required for Clinical Vignette.
PubMed: 38708913
DOI: 10.5603/ep.99376 -
Medicine May 2024Primary hyperparathyroidism, though relatively prevalent among endocrine disorders, affecting 1% of the general population, often presents diagnostic challenges. Given...
RATIONALE
Primary hyperparathyroidism, though relatively prevalent among endocrine disorders, affecting 1% of the general population, often presents diagnostic challenges. Given its potential to precipitate severe complications including nephrolithiasis and fractures, timely diagnosis, and effective management are crucial.
PATIENT CONCERNS
A 38-year-old woman with hypercalcemia was referred to the Department of Nuclear Medicine for a Tc-99m MIBI scan.
DIAGNOSES
Tc-99m MIBI scan showed focal increased uptake in the left thyroid gland area, initially suggesting a parathyroid adenoma. Further examination using SPECT/CT revealed a nodular lesion within the left thyroid gland showing high Tc-99m MIBI uptake.
INTERVENTIONS
Left thyroid lumpectomy confirmed the lesion as follicular thyroid carcinoma. On the second Tc-99m MIBI scan conducted after total thyroidectomy, a parathyroid adenoma was eventually detected in the right lower area, enabling the subsequent appropriate treatment, a right lower parathyroidectomy.
OUTCOMES
Thirteen days after the parathyroidectomy, serum levels of total calcium and parathyroid hormone returned to normal. Furthermore, bone mineral density evaluated using DEXA remained within the expected range for her age even after 14 months.
LESSONS
When interpreting the Tc-99m MIBI scan, it is essential to keep in mind that various tumors rich in mitochondria, such as thyroid carcinoma, could show a high uptake of Tc-99m MIBI.
Topics: Humans; Female; Adult; Parathyroid Neoplasms; Technetium Tc 99m Sestamibi; Incidental Findings; Adenocarcinoma, Follicular; Diagnosis, Differential; Thyroid Neoplasms; Radiopharmaceuticals; Adenoma; Single Photon Emission Computed Tomography Computed Tomography
PubMed: 38701245
DOI: 10.1097/MD.0000000000038107 -
Cleveland Clinic Journal of Medicine May 2024
Topics: Humans; Parathyroidectomy; Referral and Consultation
PubMed: 38692702
DOI: 10.3949/ccjm.91a.23076