National Cancer Institute®
Last Modified: November 21, 2001
UI - 21397988
AU - Rubello D; Piotto A; Pagetta C; Pelizzo M; Casara D
TI - Ectopic parathyroid adenomas located at the carotid bifurcation: the role of preoperative Tc-99m MIBI scintigraphy and the intraoperative gamma probe procedure in surgical treatment planning.
SO - Clin Nucl Med 2001 Sep;26(9):774-6
AD - Nuclear Medicine Service 2, Regional Hospital and University of Padova, via Giustiniani 2, 35100 Padua, Italy.
PURPOSE: The prevalence of ectopic parathyroid adenoma (PA) is relatively low, despite some studies in which it has been reported to be as high as 20%. Ectopic PA is a frequent cause of surgical failure, and therefore some authors recommend preoperative imaging to localize the condition in patients with primary hyperparathyroid (HPT) disease before initial surgery. METHODS: Two unusual cases of primary HPT caused by an ectopic PA located at the carotid bifurcation are reported. The patients were examined before operation using Tc-99m MIBI scintigraphy and then underwent radioguided surgery using the intraoperative gamma probe technique with injection of a low dose (37 MBq; 1 mCi) of Tc-99m MIBI. RESULTS: The first patient had a history of primary HPT and coexisting multinodular goiter. She had undergone total thyroidectomy in another center, but no enlarged parathyroid gland was found at bilateral neck exploration and serum calcium and parathyroid hormone levels remained elevated after intervention. The patient was referred to our center. A Tc-99m MIBI scan showed a focus of abnormal tracer uptake in the superior left laterocervical region that was thought to be a PA. The next day she underwent radioguided surgery and an 18-mm PA located at the left carotid bifurcation was easily removed through a 2.5-cm skin incision. The second patient was examined in our center before surgery. A neck ultrasound showed a multinodular goiter but no enlarged parathyroid glands. A pertechnectate-MIBI subtraction scan revealed a focus of abnormal Tc-99m MIBI uptake in the right superior laterocervical region that was thought to be a PA. One week later, at radioguided surgery, a 25-mm PA was identified at the right carotid bifurcation and removed successfully. CONCLUSIONS: These data strongly support the utility of preoperative imaging with Tc-99m MIBI in patients with primary HPT before initial neck exploration with the aim of avoiding surgical failure. Furthermore, the intraoperative gamma probe technique seems to be useful to reduce surgical trauma and, possibly, complications in patients with ectopic PA.
UI - 21415194
AU - Kacker A; Komisar A
TI - Unilateral versus bilateral neck exploration in parathyroid surgery: an assessment of 55 cases.
SO - Ear Nose Throat J 2001 Aug;80(8):530-2, 534
AD - Department of Otolaryngology-Head and Neck Surgery, Lenox Hill Hospital, 100 E. 77th St., New York, NY 10021, USA.
We retrospectively evaluated the cases of 55 patients who had undergone surgery for primary hyperparathyroidism at our institution to determine whether their parathyroid glands were abnormal on both sides. Thirty-six of these patients had undergone a bilateral neck exploration, and 19 had had a unilateral investigation. Of the 36 bilaterally explored patients, 30 had a solitary adenoma and no parathyroid pathology on the opposite side, five patients had hyperplastic glands with more than one gland involved, and one patient had two adenomas. In the unilaterally explored group, all 19 patients had a solitary adenoma. There were no failures in the way of persistent hypercalcemia in either group. Based on our findings, we conclude that a unilateral neck exploration should be performed during surgery for primary hyperparathyroidism whenever a large parathyroid adenoma and a normal parathyroid gland are found on the same side. Bilateral exploration should be reserved for patients in whom pathology cannot be found on the initially explored side during surgery and for patients who have obvious parathyroid hyperplasia.
UI - 21300307
AU - Bergwitz C; Bremer B; Soudah B; Mayr B; Brabant G
TI - Familial isolated parathyroid adenoma in a consanguineous family.
SO - J Endocrinol Invest 2001 May;24(5):349-55
AD - Dept. of Clinical Endocrinology, Medical School of Hannover, Germany. email@example.com
The 23-year-old Caucasian male propositus presented with symptomatic hypercalcemia, hypophosphatemia and normocalciuria for 2 months. His 29-year-old brother had undergone an operation for recurrent parathyroid adenoma at age 26 and 28. No other member of the family was affected. His father and mother were second-degree relatives. Laboratory studies showed primary hyperparathyroidism (pHPT), while the remaining endocrine studies and genetic testing for multiple endocrine neoplasia 1 and 2A were normal. Technetium-cardiolite scintigraphy and ultrasound scans revealed a parathyroid mass at the left lower neck. Apart from bilateral hearing loss due to gentamicin treatment as a pre-term child, the patient was in of good health. Signs or symptoms of other endocrinopathies were absent. The patient was referred for parathyroidectomy with subsequent autotransplantation of the remaining glands into his sternocleidomastoid muscle. Histological examination revealed an adenoma with oncocytic differentiation, similar to that seen in his brother. The disease may follow a recessive mode of inheritance or may be due to a dominant germ-cell mutation in one of the parents. The presented case may ultimately help in elucidating the molecular genetic basis of this rare form of pHPT.
UI - 21344950
AU - Demirkol MO; Birinci HS; Kadioglu A
TI - Intense skeletal lesions in a patient with primary hyperparathyroid disease.
SO - Clin Nucl Med 2001 Aug;26(8):727-8
AD - Department of Nuclear Medicine, Kosuyolu Heart and Research Hospital, Istanbul, Turkey. firstname.lastname@example.org
UI - 21302902
AU - Schmidt H; Kusser B; Spelsberg F
TI - Asymptomatic hypercalcemia due to an ectopic parathyroid adenoma in an 8-year-old boy.
SO - Exp Clin Endocrinol Diabetes 2001;109(3):184-6
AD - Kinderklinik und Kinderpoliklinik im Dr. v. Haunerschen Kinderspital der Universitat Munchen, Germany.
The diagnosis of primary hyperparathyroidism in children is often delayed and is usually based on symptoms of hypercalcemia rather than abnormal laboratory values alone. We report the case of an 8-year-old boy with hypercalcemia, hypophosphatemia and mildly, but inadequately elevated intact parathyroid hormone (iPTH) who presented without any symptoms of hyperparathyroidism. Although imaging studies were misleading and four normal parathyroid glands were found intraoperatively, exploration of the thymus revealed an ectopic parathyroid adenoma. After removal of the ectopic gland, a rapid iPTH immunoassay proved immediate normalization of iPTH. This is the first report of sporadic isolated primary hyperparathyroidism diagnosed in an asymptomatic child on the basis of hypercalcemia and hypophosphatemia.
UI - 21301911
AU - Shaha AR; Ferlito A; Rinaldo A
TI - Distant metastases from thyroid and parathyroid cancer.
SO - ORL J Otorhinolaryngol Relat Spec 2001 Jul-Aug;63(4):243-9
AD - Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. email@example.com
Thyroid cancer represents a unique biological tumor where even with the high incidence of distant metastases, the overall prognosis is not as poor as many other human cancers. The overall long-term survival in patients presenting initially with distant metastasis is approximately 50%. The overall incidence of distant metastases varies between 10 and 35%, depending upon the histology. The overall incidence is directly related to various histologies - being least in papillary thyroid carcinoma (10%) and highest in Hurthle cell tumor (33%). The incidence of distant metastases is also very high in patients with medullary and anaplastic thyroid cancer. The incidence of distant metastases at the time of initial presentation in differentiated thyroid cancer is approximately 4%. In high-risk patients - especially in patients with extrathyroidal extension or massive nodal metastasis - the distant metastases can be evaluated after total thyroidectomy with radioactive iodine ablation. Pulmonary metastases are very common in young individuals, but they are extremely well treated and the mortality from distant metastases in this group is very low. However, distant metastases in patients with poorly-differentiated carcinoma have a poor prognosis. In high-risk patients, generally a total thyroidectomy should be undertaken so that the patient can undergo radioactive iodine dosimetry and ablation as indicated. The surveillance in patients with thyroid cancer includes: close clinical follow-up, chest X-ray, and radioactive iodine dosimetry. Thyroglobulin is commonly used as a prognostic marker in patients having undergone total thyroidectomy. The incidence of distant metastases in medullary thyroid cancer is high, mainly to the lung and liver. Persistent hypercalcitonemia is an indication of regional or distant metastases. A variety of diagnostic tests are helpful, such as octreotide scanning, computed tomography scan, magnetic resonance imaging and positron emission tomography scan. Laparoscopy to evaluate the surface of the liver is also an important investigation to detect distant metastases. The incidence of distant metastases is very high in patients with anaplastic thyroid cancer, but most of the time the outcome depends on the locoregional recurrence and massive disease in the central compartment. The parathyroid cancer is quite rare, less than 1%, in patients undergoing parathyroidectomy. The diagnosis of parathyroid cancer is made by pathological features but the most certain method of diagnosis of a malignant tumor of the parathyroid is the identification of secondary deposits. The incidence of distant metastasis is difficult to determine due to the rarity of this condition, but the most common site is the lung. Patients with distant metastasis have recurrent progressive hypercalcemia along with high parathormone level. Copyright 2001 S. Karger AG, Basel
UI - 20303470
AU - Goshen O; Aviel-Ronen S; Dori S; Talmi YP
TI - Brown tumour of hyperparathyroidism in the mandible associated with atypical parathyroid adenoma.
SO - J Laryngol Otol 2000 Apr;114(4):302-4
AD - Department of Otolaryngology-Head and Neck Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
The brown tumour of hyperparathyroidism is a localized bone tumour and an uncommon manifestation of hyperparathyroidism. A 27-year-old woman presented with a mandibular 8 x 10 cm solid mass diagnosed as central giant cell granuloma. Chemical blood analysis revealed increased serum calcium levels of 12.46 mg/dL and the parathyroid hormone level was 124 pg/dL. The patient underwent surgery with removal of a parathyroid mass. Histologically, this parathyroid tissue was seen to be limited by a fibrous capsule with morphological features consistent with atypical parathyroid adenoma. The mandibular tumour has receded and the patient declined further procedures. This is the first case reported of brown tumour as the primary manifestation of an atypical parathyroid adenoma, a lesion that shares some features with parathyroid carcinoma without the unequivocal properties of malignancy.
UI - 21381198
AU - Horanyi J; Duffek L; Darvas K; Szlavik R; Pinkola K; Dabasi G; Horvath C
TI - [New intraoperative diagnostic methods in parathyroid surgery: intraoperative measurement of parathyroid hormone]
SO - Orv Hetil 2001 Jun 24;142(25):1327-9
AD - Altalanos Orvostudomanyi Kar, I. Sebeszeti Klinika, Semmelweis Egyetem, Budapest. intraoperative intact parathyroid hormone level were studied. Preoperative samples of blood were taken from a peripheral vein before the beginning the operation. The second sample was taken 5 minutes after removal of parathyroid adenoma. The plasma intact parathyroid hormone concentration was measured by quick IRMA method. The preoperative high PTH levels reduced after excision of adenoma to the mean 18%. 33 patients had normal PTH levels after 5 minutes of removing. The total measuring time of quick PTH assay was about 30 minutes. The QPTH assay was a quantitative adjunct for the surgeon to ensure a successful parathyroidectomy. When the intraoperative QPTH level is not reduced to 50%, then the exploration should be continued and the probability of reoperation is decreased. They propose the application of the routine intraoperative measurement of QPTH level in all parathyroidectomy.
UI - 21446356
AU - Cundiff JG; Portugal L; Sarne DH
TI - Parathyroid adenoma after radioactive iodine therapy for multinodular goiter.
SO - Am J Otolaryngol 2001 Sep-Oct;22(5):374-5
AD - University of Illinois at Chicago, College of Medicine, Chicago, IL, USA.
The development of hyperparathyroidism after radioactive iodine (RAI) therapy has been reported in 38 cases in the literature. However, the development of a parathyroid adenoma after RAI therapy for a hyperfunctioning multinodular goiter has not been reported. This report describes the pathologic and operative finding on a patient with both hyperthyroidism and hyperparathyroidism, which was diagnosed after previous RAI therapy for a toxic, multinodular goiter.
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