Table of Contents
1
UI - 11889154
AU - Burski K; Torjussen B; Paulsen AQ; Boman H; Bollerslev J
TI -
Parathyroid adenoma in a subject with familial hypocalciuric
hypercalcemia: coincidence or causality?
SO - J Clin Endocrinol Metab 2002 Mar;87(3):1015-6
AD - Section of Endocrinology, Department of Medicine, National University
Hospital, N-0027 Oslo, Norway.
A middle-aged woman presented with a history of constipation, easy
fatigue, depressive mood, lassitude, polydipsia, and polyuria. The
patient posed a challenging diagnostic dilemma due to the presence of
persistent severe hypercalcemia and relative lack of clinically
manifested symptoms. Clinical, biochemical, and genetic examinations
confirmed the diagnosis of familial hypocalciuric hypercalcemia as a
result of C562Y calcium-sensing receptor mutation, and a coexisting
parathyroid adenoma. After adenectomy, the patient's clinical situation
improved markedly, and a modest equilibrium hypercalcemia persisted.
This case presents an unusual combination of two relatively common
endocrine disorders.
2
UI - 11891946
AU - Absher KJ; Truong LD; Khurana KK; Ramzy I
TI -
Parathyroid cytology: avoiding diagnostic pitfalls.
SO - Head Neck 2002 Feb;24(2):157-64
AD - Department of Pathology, Baylor College of Medicine, One Baylor Plaza,
Houston, TX 77030, USA. iramzy@bcm.tmc.edu
BACKGROUND: Interpretation of parathyroid fine-needle aspirates (FNA)
remains problematic not only because this type of specimen is rare but
also because the pertinent literature is very limited. We systematically
reviewed parathyroid FNAs in our files and sought to delineate
additional diagnostic criteria. DESIGN: Review of all thyroid and
parathyroid lesions. The final diagnoses included four parathyroid
adenomas, one intrathyroidal hyperplastic parathyroid, one
intrathyroidal parathyroid adenoma, one atypical parathyroid adenoma
(all confirmed by histologic screening or immunocytochemistry), and five
parathyroid cysts (all confirmed by immunoassay). Papanicolaou and Diff
Quik-stained smears of the parathyroid FNAs were reviewed. The cytologic
features were compared and contrasted with those of thyroid FNAs to
establish criteria for differential diagnoses. RESULTS: The FNAs of the
five parathyroid cysts yielded virtually acellular fluid with a
characteristic water-clear appearance and markedly elevated levels of
parathyroid hormone. The remaining seven aspirates consisted of
moderately cellular smears that showed an admixture of architectural
features. Common patterns included cohesive three-dimensional groups,
disorganized sheets, papillary fragments, microfollicles, and a single
case showing lymphoidlike smears. Although the cells were generally
small and round to oval, all cases demonstrated mild to moderate
anisokaryosis. The nuclei were hyperchromatic E with coarsely granular
chromatin reminiscent of that of small lymphocytes. Occasional nucleoli
were noted. Although the cytoplasm was usually pale blue and finely
granular with ill-defined borders, two cases showed well-delineated
cytoplasmic membranes. Less common findings included cytoplasmic
granulation, vacuolization, and rare oxyphilic cells. Naked nuclei were
noted in the background of all of the aspirates to varying degrees.
Other background findings included the presence of colloidlike material,
macrophages, and lymphocytes. One interesting finding that to date has
not been reported is the presence of nuclear overlapping (100%) and
nuclear molding (71%), which is an uncommon finding in thyroid
aspirates. CONCLUSIONS: FNAs of the parathyroid can be easily confused
with that of the thyroid, not only because of the clinical similarity
between these two types of lesions but also because of the overlap in
cytomorphologic features of the aspirated cells. Although no one single
cytomorphologic feature is diagnostic, a combination of cytologic
parameters noted earlier should raise the possibility of a parathyroid
lesion. Aspirates of parathyroid cysts show acellular water-clear fluid
with elevated parathyroid hormone measurements. Copyright 2002 John
Wiley & Sons, Inc.
3
UI - 11870476
AU - Berczi C; Mezosi E; Galuska L; Varga J; Bajnok L; Lukacs G; Balazs G
TI -
Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs
ultrasonography for preoperative localization in primary
hyperparathyroidism.
SO - Eur Radiol 2002 Mar;12(3):605-9
AD - First Department of Surgery, P.O. Box 27, University of Debrecen,
Hungary 1, Nagyerdei str. 98, 4012 Debrecen, Hungary.
berczi@jaguar.dote.hu
A prospective study was performed to evaluate the efficacy of
technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction
scanning and US for imaging parathyroid glands in primary
hyperparathyroidism. Sixty-three patients were surgically treated for
primary hyperparathyroidism (HPT). Preoperative scintigraphy and US were
performed in all cases. Bilateral neck exploration was carried out on
each patient. Results of radionuclide studies and US were compared with
surgical and histological findings. In 57 patients with primary HPT the
radionuclide scanning gave true-positive results. Four false-negative
and two false-positive scintigrams were obtained. The sensitivity and
the positive predictive value (PPV) of scintigraphy were 93 and 97%,
respectively. Forty-one cases were correctly localized by the US.
Seventeen US results were false negative and five were false positive.
The sensitivity and the PPV for US were 71 and 89%, respectively. There
was a statistically significant difference between the sensitivity of
the scintigraphy compared with the US ( p=0.001). Sensitivities of
radionuclide scans and US were higher for adenomas (100 and 83%) than
for hyperplastic glands (75 and 40%). The sensitivity of
technetium-99m-sestamibi and technetium-99m-pertechnetate subtraction
scintigraphy was significantly higher compared with US. This sensitive
method could help surgeons in performing a rapid and directed
parathyroidectomy.
4
UI - 11680065
AU - Emmelot-Vonk MH; Samson MM; Raymakers JA
TI -
[Cognitive deterioration in elderly due to primary
hyperparathyroidism--resolved by parathyroidectomy]
SO - Ned Tijdschr Geneeskd 2001 Oct 13;145(41):1961-4
AD - Universitair Medisch Centrum, afd. Geriatrie, Postbus 85.500, 3805 GA
Utrecht. m.h.emmelotvonk@digd.azu.nl
Three patients, two women aged 79 and 80 and a man aged 84, showed
symptoms of cognitive impairment caused by primary hyperparathyroidism.
Parathyroidectomy lead to a marked improvement in the symptoms. The
incidence of primary hyperparathyroidism increases with age. Most
patients only show slight symptoms. In addition, clinical symptoms in
elderly patients differ from those in younger patients with mental
changes, general tiredness and reduced muscular strength being
prevalent. In accordance with the literature, which shows high cure
rates with low morbidity and mortality, we recommend that parathyroid
surgery be considered in elderly patients who exhibit only slight or
mental symptoms of primary hyperparathyroidism.
5
UI - 11845573
AU - Mannesse CK; van Ouwerkerk BM; Willemse AP
TI -
[Cognitive deterioration in the elderly due to primary
hyperparathyroidism--resolved by parathyroidectomy]
SO - Ned Tijdschr Geneeskd 2002 Jan 26;146(4):188
6
UI - 11852306
AU - Rubello D; Casara D; Fiore D; Muzzio P; Zonzin G; Shapiro B
TI -
An ectopic mediastinal parathyroid adenoma accurately located by a
single-day imaging protocol of Tc-99m pertechnetate-MIBI subtraction
scintigraphy and MIBI-SPECT-computed tomographic image fusion.
SO - Clin Nucl Med 2002 Mar;27(3):186-90
AD - Service of Nuclear Medicine 2, Department of Radiotherapy, General
Hospital of Padova, Italy. dario.casara@unipd.it
PURPOSE: Because ectopic parathyroid adenoma (PA) is a frequent cause of
failed initial surgery, an imaging approach with accurate preoperative
localization is recommended by some authors in patients with primary
hyperparathyroidism (HPT). METHODS: The authors describe a 52-year-old
woman in whom primary HPT was diagnosed incidentally during a screening
program for osteoporosis. The peculiarity of this case is that the
patient was examined before operation in a single-day multimodal imaging
protocol based on the combination of high-resolution cervical
ultrasound, planar Tc-99m pertechnetate-MIBI scans, and an
MIBI-SPECT-computed tomographic (CT) image fusion study. An ectopic PA
was accurately located in the upper middle mediastinum, close to the
lower margin of the sternal notch. RESULTS: Guided by the MIBI-SPECT-CT
fusion images, the surgeon performed a limited median sternotomy and
easily removed the PA that was revealed before operation. To confirm the
completeness of resection, a bilateral neck exploration was performed
through the same incision, with identification of three normally sized
parathyroid glands. CONCLUSIONS: Our experience suggests the utility of
multimodality imaging procedures for the accurate preoperative
localization of PAs, particularly when they are present in ectopic
mediastinal locations. Such procedures, including the MIBI-SPECT-CT
image fusion study, can be performed in a single day.
7
UI - 11852320
AU - Arslan N; Rydzewski B
TI -
Detection of a recurrent parathyroid carcinoma with FDG positron
emission tomography.
SO - Clin Nucl Med 2002 Mar;27(3):221-2
AD - Edward Mallinckrodt Institute of Radiology, Washington University School
of Medicine, St. Louis, Missouri, USA. nuria_tr@yahoo.com
8
UI - 11933634
AU - Lalanne-Mistrih ML; Ognois-Ausse P; Goudet P; Cougard P
TI -
[Giant parathyroid tumors: characterization of 26 glands weighing more
than 3.5 grams]
SO - Ann Chir 2002 Mar;127(3):198-202
AD - Service d'endocrinologie-nutrition, hopital du Bocage, CHU de Dijon,
21000 Dijon, France.
AIM OF THE STUDY: To determine the characteristics of giant lesions of
the parathyroid glands weighting more than 3.5 g. PATIENTS AND METHOD:
Twenty-six patients operated on between 1989 to 2001 were included in
this retrospective study. Anatomical, biological, clinical and
histological parameters were analyzed. Data were compared both with a
personnal series of the last 220 patients with hyperparathyroidism
operated on in our department and with the results of a primary
hyperparathyroidism multicentric study conducted by the French
Association of Surgery (AFC). RESULTS: They were 14 females and 12 males
with a mean age of 58.57 +/- 13.72 years (ranged: 26-80). Mean weight of
the parathyroid glands was 9.87 +/- 9.76 g (ranged: 3.5-40). The
diagnosis of parathyroid disease was suspected by symptoms and
incidentally discovered hypercalcemia in 17 and 8 cases respectively. In
one case, the adenoma was misdiagnosed as a thyroid nodule. Mean
calcemia was 125.42 +/- 19.6 mg/L, mean phosphoremia was 21.6 +/- 6.9
mg/L, mean seric parathormone concentration was 451.44 +/- 530.18 ng/L.
Comparing with our personnel 220 HPT-series, they was no statistically
difference concerning the mean age, but number of males and biological
measurements were significantly higher in presence of a giant adenoma.
Comparing with the study of the AFC group, there was no statistically
difference concerning the symptoms, especially in regard to the
asymptomatic forms discovered by hypercalcemia and to the acute
hypercalcemia forms. Minor ectopic localizations were found in half of
the cases. All the glands were considered as beginnings. After surgery,
one patient had a severe hypocalcemia in relation to a hungry bone
syndrome. CONCLUSION: Giant adenomas have no specific symptoms even if
functional status seems to be more active. Diagnosis is made during the
sixth decade as usual. Male people are more often concerned. At surgery
ectopic localizations are present in 50% of the cases. In our study
their size is not a sign of malignancy. After surgery severe
hypocalcemia can occur if a long past of bone disease exists.
9
UI - 11914679
AU - Boulahdour H; Bertrand AM; Klingelschmitt S; Rudenko B; Loboguerrero A;
TI -
Bidet AC; Mantion G; Cardot JC
Parathyroid adenoma visualization on octreotide scintigraphy.
SO - Clin Nucl Med 2002 Apr;27(4):304-5
AD - Department of Nuclear Medicine, CHU Jean Minjoz, Boulevard Alexandre
Fleming, 25000 Besancon, France. hatem.boulahdour@ufc-chu.univ-fcomte.fr
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