-
Kulak Burun Bogaz Ihtisas Dergisi : KBB... 2015This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing...
OBJECTIVES
This study aims to identify the diagnostic capacity of the technetium 99m sestamibi scintigraphy with single photon emission computed tomography for localizing parathyroid pathologies.
PATIENTS AND METHODS
Data of 13 patients (4 males, 9 females; mean age 49.23 years; range 27 to 63 years) who had minimally invasive parathyroidectomy due to primary hyperparathyroidism at the Haseki Training and Research Hospital Ear-Nose-Throat clinic between January 2013 and December 2013 were retrospectively analyzed. Two patients were excluded due to incomplete documentation.
RESULTS
Mean preoperative parathyroid hormone and calcium levels were 284.36 (134-1,083 pg/mL) and 11.9 (10.7-13.5 mg/dL), respectively. The operation was deemed adequate if intraoperative parathyroid hormone dropped by 50% from the preoperative level or frozen section analysis showed hypercellular gland or adenoma. Only sestamibi scintigraphy results were consistent with focal exploration findings in all patients. Focal exploration and parathyroid adenoma excision via minimally invasive parathyroidectomy were successfully carried out in 10 patients with single adenoma confirmed by sestamibi.
CONCLUSION
Technetium 99m sestamibi scintigraphy with single photon emission computed tomography and frozen section analysis may provide more meaningful information and be more advantageous compared to other preoperative localization techniques.
Topics: Adenoma; Adult; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Parathyroid Neoplasms; Parathyroidectomy; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon
PubMed: 26211860
DOI: 10.5606/kbbihtisas.2015.33678 -
Endocrine Regulations Jan 2023Hyperparathyroidism is a prevalent disease with parathyroid adenomas being the most common cause. Surgical excision remains the standard treatment for parathyroid...
Hyperparathyroidism is a prevalent disease with parathyroid adenomas being the most common cause. Surgical excision remains the standard treatment for parathyroid adenoma. Successful preoperative localization of the parathyroid adenoma could facilitate the decision regarding the extent of surgical exploration. The aim of the current study was to assess the correlation between the preoperative values of parathyroid hormone and ionized calcium with the adenoma weight and volume in patient with primary hyperparathyroidism caused by single-gland adenoma. We did this retrospective review for all patients who were diagnosed with primary hyperparathyroidism due to a solitary parathyroid adenoma in our general surgery department over 4 years. SPSS software was used to get the correlation coefficient between the peak preoperative levels of calcium and parathyroid hormone with the parathyroid adenoma weight and volume. Ninety-nine patients were included into the study. The average age at surgery was 62.65±12.00 years. The correlation coefficient between the adenoma volume and weight with the preoperative ionized calcium level was weakly positive (r=0.329, p<0.01) and (r=0.281, p=0.019), respectively, while the correlation with the preoperative parathyroid hormone level was stronger (r=0.708, p<0.01) and (r=0.650, p<0.01), respectively. The strong positive relationship between the preoperative parathyroid hormone and calcium levels with the parathyroid adenoma size and weight can help the surgeon to predict the volume of the involved gland and avoid an unnecessary dissection.
Topics: Humans; Middle Aged; Aged; Parathyroid Glands; Calcium; Parathyroid Neoplasms; Hyperparathyroidism, Primary; Parathyroid Hormone; Parathyroidectomy; Adenoma; Retrospective Studies
PubMed: 36753663
DOI: 10.2478/enr-2023-0002 -
Medicina 2023Hyperparathyroidism-induced hypercalcemic crisis (HIHC) is an unusual state of marked progressive primary hyperparathyroidism (PHPT). Patients have severe hypercalcemia...
Hyperparathyroidism-induced hypercalcemic crisis (HIHC) is an unusual state of marked progressive primary hyperparathyroidism (PHPT). Patients have severe hypercalcemia and may have severe symptoms such as kidney failure, acute pancreatitis, and mental changes. PHPT is due to the presence of a single gland adenoma/ disease in 80 to 85%; parathyroid carcinoma is reported in <1%. Among patients with adenoma, atypical parathyroid tumor can be found infrequently. Parathyroidectomy is the only curative approach for PHPT. In this report we present three cases of HIHC due to giant parathyroid adenomas (GPAs), one of them with histopathological characteristics of an atypical parathyroid tumor, with satisfactory evolution after parathyroidectomy.
Topics: Humans; Hypercalcemia; Parathyroid Neoplasms; Hyperparathyroidism, Primary; Acute Disease; Pancreatitis; Adenoma
PubMed: 37870339
DOI: No ID Found -
Indian Pediatrics Aug 2006
Topics: Adenoma; Child; Humans; Hyperparathyroidism; Male; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging
PubMed: 16951447
DOI: No ID Found -
CEN Case Reports Feb 2021Hypercalcemia is usually secondary to one etiology, although two coexisting etiologies can rarely cause hypercalcemia. Here, we report a 47-year-old woman with...
Hypercalcemia is usually secondary to one etiology, although two coexisting etiologies can rarely cause hypercalcemia. Here, we report a 47-year-old woman with hypercalcemia caused by comorbid parathyroid adenoma and pulmonary tuberculosis. Primary hyperparathyroidism is the most common cause of hypercalcemia. Tuberculosis is a rare cause of hypercalcemia, but Japan continues to have an intermediate tuberculosis burden. Therefore, tuberculosis should be considered as a cause of hypercalcemia in Japan. Patients with tuberculosis are often asymptomatic, making the diagnosis difficult. In the previous cases in which these diseases coexisted, one disease was diagnosed after treatment of the other. In our case, the very high 1,25-dihydroxyvitamin D level (162 pg/mL) helped us to diagnose asymptomatic tuberculosis and both diseases were diagnosed promptly. It is necessary to consider comorbidities, including tuberculosis in a case with a very high 1,25-dihydroxyvitamin D level. We report a valuable case in which the early diagnosis and treatment of tuberculosis and primary hyperparathyroidism prevented the spread of tuberculosis.
Topics: Antitubercular Agents; Bone Density; Comorbidity; Early Diagnosis; Female; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Treatment Outcome; Tuberculosis, Pulmonary; Vitamin D
PubMed: 32632908
DOI: 10.1007/s13730-020-00509-2 -
AJNR. American Journal of Neuroradiology Sep 2020Parathyroid gland weight is a clinically relevant parameter used to diagnose parathyroid adenomas intraoperatively. We evaluated the accuracy of a formula to estimate...
BACKGROUND AND PURPOSE
Parathyroid gland weight is a clinically relevant parameter used to diagnose parathyroid adenomas intraoperatively. We evaluated the accuracy of a formula to estimate parathyroid weight on preoperative 4D-CT.
MATERIALS AND METHODS
A single-institution retrospective study was performed in patients with primary hyperparathyroidism who underwent 4D-CT between January 2013 and December 2014 with subsequent parathyroidectomy and surgical cure. All patients had correct localization of a solitary parathyroid adenoma. The longest 3 dimensions of all identified parathyroid glands were measured on CT, and weight was estimated using the formula: weight (mg) = 1 mg/mm × Length (mm) × Width (mm) × Height (mm) × π/6. We correlated weight with pathology specimen weight (weight). Using receiver operating characteristic analysis, we estimated the performance of weight to discriminate a parathyroid adenoma from normal glands on 4D-CT and determined the optimal threshold based on the Youden index.
RESULTS
One hundred sixteen patients (85 women, 31 men) were evaluated. Weight was shown to be strongly correlated with weight as demonstrated by Spearman ρ = 0.73 ( < .01), concordance correlation coefficient = 0.92 (95% CI, 0.89-0.94), and Cronbach α = 0.96. The performance of weight for the diagnosis of parathyroid adenoma was excellent, with an area under the curve of 0.955 (95% CI, 0.925-0.985; < .001). Based on the Youden index, the optimal threshold was >50 mg, with a sensitivity of 96.7% and a specificity of 95.7%.
CONCLUSIONS
Radiologists can accurately estimate parathyroid adenoma weight on 4D-CT. This metric is highly correlated with pathologic weight, and a threshold cutoff of >50 mg can be used to distinguish parathyroid adenoma from normal glands.
Topics: Adenoma; Adult; Aged; Algorithms; Female; Four-Dimensional Computed Tomography; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Organ Size; Parathyroid Neoplasms; ROC Curve; Retrospective Studies
PubMed: 32816774
DOI: 10.3174/ajnr.A6687 -
The Journal of Clinical Endocrinology... Jun 2023To define somatic variants of parathyroid adenoma (PA) and to provide novel insights into the underlying molecular mechanism of sporadic PA.
OBJECTIVE
To define somatic variants of parathyroid adenoma (PA) and to provide novel insights into the underlying molecular mechanism of sporadic PA.
METHODS
Basic clinical characteristics and biochemical indices of 73 patients with PA were collected. Whole-exome sequencing was performed on matched tumor-constitutional DNA pairs to detect somatic alterations. Functional annotation was carried out by ingenuity pathway analysis afterward. The protein expression of the variant gene was confirmed by immunohistochemistry, and the relationship between genotype and phenotype was analyzed.
RESULTS
Somatic variants were identified in 1549 genes, with an average of 69 variants per tumor (range, 13-2109; total, 9083). Several novel recurrent somatic variants were detected, such as KMT2D (15/73), MUC4 (14/73), POTEH (13/73), CD22 (12/73), HSPA2 (12/73), HCFC1 (11/73), MAGEA1 (11/73), and SLC4A3 (11/73), besides the previously reported PA-related genes, including MEN1 (11/73), CASR (6/73), MTOR (4/73), ASXL3 (3/73), FAT1 (3/73), ZFX (5/73), EZH1 (2/73), POT1 (2/73), and EZH2 (1/73). Among them, KMT2D might be the candidate driver gene of PA. Crucially, 5 patients carried somatic mutations in CDC73, showed an aggressive phenotype similar to that of parathyroid carcinoma (PC), and had a decreased expression of parafibromin. Pathway analysis of recurrent potential PA-associated driver variant genes revealed functional enrichments in the signaling pathway of Notch.
CONCLUSION
Our study expanded the pathogenic variant spectrum of PA and indicated that KMT2D might be a novel candidate driver gene and be considered as a diagnostic biomarker for PA. Meanwhile, CDC73 mutations might be an early developmental event from PA to PC. The results provided insights into elucidating the pathogenesis of parathyroid tumorigenesis and a certain basis for clinical diagnosis and treatment.
Topics: Humans; East Asian People; Genomics; Mutation; Parathyroid Neoplasms
PubMed: 36611251
DOI: 10.1210/clinem/dgad002 -
Interactive Cardiovascular and Thoracic... Jun 2021The most frequent cause of suboptimal results in a parathyroid adenoma resection is an ectopic location, mainly in the anterior mediastinum. These cases may not always...
The most frequent cause of suboptimal results in a parathyroid adenoma resection is an ectopic location, mainly in the anterior mediastinum. These cases may not always be resected through a traditional cervical access. We present 2 cases of primary hyperparathyroidism who underwent an unsuccessful bilateral cervical exploration due to parathyroid tissue located inside the thymic gland. A video-assisted thoracoscopic surgery thymectomy with intraoperative determination of blood parathormone levels was performed. A 50% reduction of intraoperatory parathyroid hormone blood from the highest basal level at 5 and 10 min after resection was obtained. Final pathological results showed an intra-thymic parathyroid adenoma in the first patient and an intra-thymic focus of parathyroid hyperplasia in the second patient. In conclusion, video-assisted thoracoscopic surgery thymectomy could be the optimal approach to resect ectopic parathyroid adenomas located in the anterior mediastinum.
Topics: Adenoma; Humans; Mediastinum; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy
PubMed: 33893507
DOI: 10.1093/icvts/ivab043 -
Nuclear Medicine Review. Central &... 2020
Topics: Biological Transport; Female; Humans; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Sodium Pertechnetate Tc 99m
PubMed: 33007102
DOI: 10.5603/NMR.2020.0023 -
The Thoracic and Cardiovascular Surgeon Oct 2022Rare ectopic mediastinal parathyroid adenoma can result in persistent or recurrent hyperparathyroidism. In this article, we summarized the perioperative outcomes of six...
Rare ectopic mediastinal parathyroid adenoma can result in persistent or recurrent hyperparathyroidism. In this article, we summarized the perioperative outcomes of six patients with mediastinal parathyroid adenoma. All patients underwent minimally invasive surgery (MIS). Abnormal accumulation of sestamibi was observed in four of five patients for preoperative localization of adenoma. Postoperatively, the blood calcium dropped quickly. In addition, we found adenoma function was negatively related to adenoma volume in these patients. In conclusion, although MIS is feasible for parathyroid adenoma, blood calcium should be monitored in a timely manner to avoid hypocalcemia postoperatively. In addition, sestamibi might be a potential pitfall when locating parathyroid adenoma.
Topics: Adenoma; Calcium; Humans; Parathyroid Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Treatment Outcome
PubMed: 35901849
DOI: 10.1055/s-0042-1750026