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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 -
Endocrine Journal Aug 2003The incidence of parathyroid carcinoma is rare. We recently encountered a case of double carcinoma, located in the right and left upper parathyroid glands. A 67-year old...
The incidence of parathyroid carcinoma is rare. We recently encountered a case of double carcinoma, located in the right and left upper parathyroid glands. A 67-year old man came to the Teikyo University Hospital because of his bilateral parathyroid masses with hypercalcemia and high parathyroid hormone (PTH). Preoperative diagnoses were parathyroid adenoma in the left lobe and papillary thyroid carcinoma or parathyroid carcinoma in the right lobe. First, the left tumor was removed; however, iPTH was still high. The right mass was then resected and iPTH fell to normal range. Histological examination revealed both tumors were parathyroid carcinoma. To the best of our knowledge, this is the first report of double parathyroid carcinoma confirmed histologically.
Topics: Aged; Carcinoma; Humans; Hypercalcemia; Male; Parathyroid Hormone; Parathyroid Neoplasms
PubMed: 14599124
DOI: 10.1507/endocrj.50.477 -
Chirurgia (Bucharest, Romania : 1990) 2017Our study underline scarcity of isolated case reports or small case series of parathyroid adenoma (PA) published in autochthonous medical literature,their variable...
UNLABELLED
Our study underline scarcity of isolated case reports or small case series of parathyroid adenoma (PA) published in autochthonous medical literature,their variable clinical expression among the "historic" varieties but also the diagnostic difficulties and delays of diagnosis as well consecration of surgery as the golden therapeutic standard of this disorder.
PATIENTS AND METHOD
Demographic, clinical presentations, laboratory and imaging data, operative findings and procedures together with pathology account and outcome from the case reports of 18 patients with documented PHP were retrospectively analyzed. The male/female ratio was 1/5, with ages ranging from 16 to 58 (mean 46) years. Renal stones (n=9) and bone sufferings (n=6) were the most common modes of presentation. To these were added psychiatric and neuromuscular complaints, digestive disorders (pancreatitis and peptic ulcer) arterial hypertension and presence of a palpable nodule. Mean serum calcium and phospho-rus, alkaline phosphatase and PTH dosage together with parathyroid ultrasound and 99m Tc sestamibi scintigraphy are the most useful parameters for diagnosis. Eighteen adenomectomies were performed of which bilateral neck exploration was done in 16 patients and minimally invasive approach in the remaining two cases. In 9 situations concomitant thyroid exeresis for associated lesions or tactical purpose were done. Pathology revealed single adenoma consisting of main and oxyphil cells in 17 cases. In one case an atypical adenoma was identified and in another case three years after removal of a benign adenoma the subject presented a clinical ipsilateral recurrence which provided to be a carcinoma. Postoperative clinical and humoral outcome was favorable in all situations less the case of carcinoma which died after 14 months. Despite the rarity and difficulties of diagnosis in cases of PA, practitioners must be aware of potential existence of these lesions in order to apply as early and appropriate treatment where surgery is the gold standard.
Topics: Adenoma; Adolescent; Adult; Alkaline Phosphatase; Biomarkers; Calcium; Female; Humans; Kidney Calculi; Male; Middle Aged; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Phosphorus; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Sestamibi; Treatment Outcome; Ultrasonography
PubMed: 28266288
DOI: 10.21614/chirurgia.112.1.18 -
Hellenic Journal of Nuclear Medicine 2020Primary hyperparathyroidism (PHPT) is a common endocrine disease that is caused by a single adenoma in most of the cases. Surgical management is the mainstay and... (Comparative Study)
Comparative Study
OBJECTIVE
Primary hyperparathyroidism (PHPT) is a common endocrine disease that is caused by a single adenoma in most of the cases. Surgical management is the mainstay and definitive treatment for parathyroid adenoma (PA). Minimally invasive surgical techniques are as effective as bilateral neck exploration with a lower risk of complications and better cosmetic results in patients with solitary PA. Accurate preoperative localization with imaging modalities is paramount for determining patients candidate for minimally invasive surgery. In this study we aimed to evaluate the diagnostic performance of technetium-99m-methoxyisobutylisonitrile ( Tc-MIBI) planar scintigraphy (PS), single photon emission tomography/computed tomography (SPET/CT) and ultrasonography (US) in patients with PHPT.
MATERIAL AND METHODS
Fifty-eight patients with biochemical evidence of PHPT who underwent pre-operative imaging with parathyroid scintigraphy and US for detection and localization of PA and proceeded to surgery were included in the study. All patients underwent dual phase Tc-sesta MIBI parathyroid scintigraphy (early and delayed planar images and delayed SPET/CT). Data analysis was performed to evaluate the sensitivity, specificity, diagnostic accuracy and PPV of planar images, SPET/CT and US alone and combined US and SPET/CT. Histopathology was used as gold standard.
RESULTS
Sensitivity, specificity, PPV and diagnostic accuracy for detection of PA, 80,4%, 42,8%, 91,1% and 75,8% for PS; 80,4%, 57,7%, 91,1% and 77,5% for delayed SPET/CT; 88,2%, 85,7%, 97,8% and 87,9% for US and 94,1%, 71,4%, 96% and 91,3% for SPET/CT+US. Combined US and SPET/CT has been shown to increase sensitivity and diagnostic accuracy. The overall sensitivity of PS and SPET/CT didn't vary however additional information which is helpful for planning minimally invasive surgery gained from tomographic images.
CONCLUSION
The combined use of US and SPET/CT has incremental value in accurately localizing PA over either technique alone. In the preoperative assessment of patients with PHPT combination of imaging methods allows selection of patients who would be suitable for minimally invasive surgery.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Neoplasms; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Sestamibi; Ultrasonography
PubMed: 32222728
DOI: 10.1967/s002449912002 -
Frontiers in Endocrinology 2023We evaluated the difference in parathyroid visualization on F-FCH PET/CT images obtained at 5 and 60 min, and quantitatively analyzed the mode of FCH uptake at...
OBJECTIVE
We evaluated the difference in parathyroid visualization on F-FCH PET/CT images obtained at 5 and 60 min, and quantitatively analyzed the mode of FCH uptake at different time points, to determine the best imaging time for FCH PET/CT.
METHODS
This retrospective study included 73 patients with hyperparathyroidism (HPT) who underwent F-FCH PET/CT imaging between December 2017 and December 2021. The diagnostic efficiency of 5- and 60-min dual time point imaging for the diagnosis of hyperparathyroidism and parathyroid adenoma and hyperplasia, were compared using visual and quantitative analyses.
RESULTS
Dual-time F-FCH PET/CT imaging visual analysis had diagnostic value for HPT. The receiver operating characteristic curve of PET/CT quantitative parameters for the diagnosis of HPT and lesions showed that the parathyroid/thyroid SUVmax ratio for 60-min imaging had a higher sensitivity and specificity (based on patient, sensitivity: 90.90% and specificity: 85.71%; based on focus, sensitivity: 83.06% and specificity: 85.71%) compared to that for 5-min imaging. PET/CT quantitative parameters can distinguish parathyroid adenoma and hyperplasia. The 60-min parathyroid SUVmax value had the highest diagnostic value (cutoff: 3.945; area under the curve: 0.783).
CONCLUSION
The quantitative parameters of 60min F-FCH PET/CT have more advantages in aiding in the pathologica diagnosis and clinical treatment of HPT.
Topics: Humans; Positron Emission Tomography Computed Tomography; Parathyroid Neoplasms; Retrospective Studies; Hyperplasia; Choline; Hyperparathyroidism
PubMed: 37113486
DOI: 10.3389/fendo.2023.1100056 -
Tuberkuloz Ve Toraks 2011Primary hyperparathyroidism is most commonly caused by either a parathyroid adenoma or parathyroid hyperplasia. Parathyroid adenomas also rarely attain huge proportions....
Primary hyperparathyroidism is most commonly caused by either a parathyroid adenoma or parathyroid hyperplasia. Parathyroid adenomas also rarely attain huge proportions. We present a case of a 63-year-old female patient causing hypercalcemia and the mass which is located in the mediastinum. High intact parathormone level secondary to an ectopic hypersecretory parathyroid adenoma were detected (642 pg/mL). It was removed via a right thoracic approach. In this case parathyroid adenoma measuring 7 x 5 x 4 cm and weighing 145 g; to our knowledge the greatest mass reported in the literature. Despite its huge size it did not cause many of the hypercalcemic symptoms.
Topics: Adenoma; Female; Humans; Hypercalcemia; Hyperparathyroidism; Mediastinum; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Treatment Outcome
PubMed: 22087523
DOI: 10.5578/tt.2419 -
BMC Endocrine Disorders Jan 2022Tumor-induced osteomalacia (TIO) is a rare, acquired disease of renal phosphate wasting and disturbed vitamin D homeostasis as a result of the action of a phosphaturic... (Review)
Review
BACKGROUND
Tumor-induced osteomalacia (TIO) is a rare, acquired disease of renal phosphate wasting and disturbed vitamin D homeostasis as a result of the action of a phosphaturic protein - FGF-23, produced by a neoplasm. Although the clinical and biochemical profile of the syndrome is characteristic, it remains underreported and unrecognized by clinicians. Hyperparathyroidism is rarely associated with oncogenic osteomalacia, but it should be considered because of potentially life-threatening hypophosphatemia caused by both conditions.
CASE PRESENTATION
We report a case of a 42-year-old woman admitted to the Department of Otolaryngology of the Military Institute of Medicine in Warsaw for the endoscopic resection of hormonally active glomangiopericytoma extending into the anterior skull base. She presented with a 5-year history of musculoskeletal pain and progressive weakness of the extremities which finally led her to become bedridden. After the excision of the tumor her symptoms and laboratory results gradually improved except increasing PTH serum levels. Further examination revealed a parathyroid proliferative tumor, which was surgically removed. The patient walked without aids at follow-up 16 months after the surgery.
CONCLUSIONS
This case is unusual because of tumor-induced osteomalacia and parathyroid adenoma occurring concomitantly. Further investigations of FGF-23 and PTH interplay should be conducted to elucidate the pathogenesis of hyperparathyroidism and tumorigenesis in some cases of TIO. By presenting this case, we wanted to remind clinicians of a rare and misdiagnosed paraneoplastic syndrome and highlight the importance of monitoring PTH concentrations during the follow-up of patients with TIO.
Topics: Adult; Female; Glomus Tumor; Humans; Osteomalacia; Paraneoplastic Syndromes; Parathyroid Neoplasms; Skull Base Neoplasms
PubMed: 35090436
DOI: 10.1186/s12902-022-00934-7 -
BMJ Case Reports Jul 2019Sarcoidosis of the parathyroid gland is a rare occurrence. Parathyroid sarcoidosis is usually associated with parathyroid adenomas, and, therefore, hypercalcaemia is a... (Review)
Review
Sarcoidosis of the parathyroid gland is a rare occurrence. Parathyroid sarcoidosis is usually associated with parathyroid adenomas, and, therefore, hypercalcaemia is a common presentation of this entity. We present a case of parathyroid sarcoidosis and review the world literature regarding this rare condition. A woman with a history of diffuse large B cell lymphoma underwent a surveillance positron emission tomography scan that showed increased fluorodeoxyglucose uptake in multiple thoracic and abdominal lymph nodes and in a left upper extremity soft tissue mass. Biopsy of the soft tissue mass showed non-caseating granulomas consistent with sarcoidosis. Blood work showed a serum calcium of 11.1 mg/dL with an intact serum parathyroid hormone of 92 pg/dL. Primary hyperparathyroidism was suspected. A neck ultrasound and sestamibi parathyroid scintigraphy demonstrated a parathyroid nodule. She underwent surgical resection, and the histopathology revealed a parathyroid adenoma and non-caseating granulomata consistent with a diagnosis of sarcoidosis.
Topics: Adenoma; Aged; Diagnosis, Differential; Female; Humans; Hypercalcemia; Parathyroid Neoplasms; Parathyroidectomy; Rare Diseases; Sarcoidosis; Treatment Outcome
PubMed: 31308180
DOI: 10.1136/bcr-2019-230598 -
Bioscience Reports Apr 2019The aim of the present study was to elucidate the diagnostic and prognostic implications of parafibromin immunohistochemistry (IHC) in parathyroid carcinoma (PC). We... (Meta-Analysis)
Meta-Analysis
The aim of the present study was to elucidate the diagnostic and prognostic implications of parafibromin immunohistochemistry (IHC) in parathyroid carcinoma (PC). We performed a meta-analysis to examine the rate of loss of parafibromin expression from 18 eligible studies. In addition, a diagnostic test accuracy review was conducted to investigate the diagnostic role of parafibromin in PC. The rates of loss of parafibromin expression were 0.522 (95% CI: 0.444-0.599), 0.291 (95% CI: 0.207-0.391), 0.027 (95% CI: 0.011-0.064), and 0.032 (95% CI: 0.008-0.119) in PC, atypical parathyroid adenoma (APA), parathyroid adenoma (PA), and parathyroid hyperplasia, respectively. In the diagnostic test accuracy review for diagnosis of PC, the pooled sensitivity and specificity of parafibromin IHC was 0.53 (95% CI: 0.46-0.59) and 0.96 (95% CI: 0.95-0.97), respectively. The diagnostic odds ratio and the area under curve on summary receiver operating characteristic curve was 25.31 (95% CI: 8.91-71.87) and 0.7954, respectively. In addition, the meta-analysis demonstrated that loss of parafibromin expression was significantly correlated with worse disease-free survival (hazard ratio: 2.832; 95% CI: 1.081-7.421). Loss of parafibromin IHC expression was significantly higher in PC than in APA, PA, and parathyroid hyperplasia. Parafibromin IHC could be useful for diagnosis and prediction of prognosis of PC in daily practice.
Topics: Biomarkers, Tumor; Disease-Free Survival; Humans; Hyperplasia; Immunohistochemistry; Parathyroid Glands; Parathyroid Neoplasms; Prognosis; ROC Curve; Tumor Suppressor Proteins
PubMed: 30926677
DOI: 10.1042/BSR20181778 -
The Israel Medical Association Journal... Jun 2003
Topics: Adenoma; Gamma Rays; Humans; Minimally Invasive Surgical Procedures; Monitoring, Intraoperative; Parathyroid Neoplasms; Parathyroidectomy; Radiography, Interventional; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Treatment Outcome
PubMed: 12841019
DOI: No ID Found