National Cancer Institute®
Last Modified: January 1, 2002
UI - 11386024
AU - Bednarek-Tupikowska G; Tolloczko T; Tupikowski W; Bogdanska M; Karwacki
TI - J; Medras M; Milewicz A Coexistence of parathyroid carcinoma and non-medullary carcinoma of the thyroid.
SO - Med Sci Monit 2001 May-Jun;7(3):448-56
AD - Department of Endocrinology and Diabetology, Medical University, ul. Pasteura 4, 50-367 Wroclaw, Poland.
A case of 35-year-old woman with parathyroid cancer is presented. Five years ago she underwent surgery for follicular thyroid cancer. Parathyroid cancer was evidenced by palpable, solid, irregularly shaped cervical tumor 5 cm in diameter. The patient had severe hyperparathyroidism confirmed by biochemical findings of hypercalcemia reaching 16 mg%, hypophosphatemia and hyperphosphatasemia. Serum parathormone level was 23-fold higher than the norm. These findings were accompanied by polyuria, polidypsia, symptoms of bone damage and renal calcification. After the surgery the patient's condition improved significantly despite persistent hyperparathyroidism. The level of parathormone decreased, but was still 11 times higher than the norm. Two months after the surgery she noticed a single node on her neck. The patient was re-operated for recurrence of parathyroid cancer. Serum parathormone level was then 6-8 times above the norm. Medical treatment with furosemide, calcitonin and biphosphonate resulted in normalization of calcemia and phosphatemia. Further management will aim at localization of foci of hyperactive parathyroid tissue in order to enable radical reoperation. The case is reported because of rare occurrence of parathyroid carcinoma as well as because the carcinoma occurred in a patient who previously had follicular thyroid cancer. There are no reports of coexistence of these two neoplasms in available literature.
UI - 11456270
AU - Hara H; Igarashi A; Yano Y; Yashiro T; Ueno E; Aiyoshi Y; Ito K; Obara T
TI - Ultrasonographic features of parathyroid carcinoma.
SO - Endocr J 2001 Apr;48(2):213-7
AD - Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Japan.
Although several authors have reported single cases illustrative of some ultrasonographic characteristic of parathyroid carcinoma, the value of ultrasonography for diagnosing this entity remains to be determined. The purpose of our study was to investigate the ultrasonographic features of parathyroid carcinoma in a large number of cases. We assessed the shape, contour, echogenicity, and depth-width (DW) ratio of 16 parathyroid carcinomas and 61 parathyroid adenomas. Ultrasonography showed that parathyroid carcinomas tend to be large, inhomogeneous, hypoechoic masses with lobulated contours. In contrast, parathyroid adenomas were small, homogeneous, hypoechoic masses with smooth borders. The mean (range) DW ratios for parathyroid carcinomas were 1.21 (0.91-2.5) and 0.64 (0.33-1.47) for adenomas; the difference was statistically significant (p<0.0001). The DW ratio was > or =1 in 15 (94%) of the 16 cases of carcinoma, whereas only 3 (5%) of the 61 adenomas had a similar ratio. Ultrasonographic examination is useful not only for preoperative localization but also for differentiating parathyroid carcinoma from adenoma. Parathyroid tumors with irregular margins, inhomogeneous echogenicity, and a DW ratio > or =1 are likely to be malignant.
UI - 11478268
AU - Bornstein-Quevedo L; Gamboa-Dominguez A; Angeles-Angeles A;
TI - Reyes-Gutierrez E; Vargas-Vorackova F; Gamino R; Herrera MF Histologic diagnosis of primary hyperparathyroidism: a concordance analysis between three pathologists.
SO - Endocr Pathol 2001 Spring;12(1):49-54
AD - Department of Pathology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Primary hyperparathyroidism (HPT) is caused by a parathyroid adenoma, hyperplasia or carcinoma. Difficulties for the histologic diagnosis of abnormal parathyroid tissue are widely recognized. The aim of the study was to evaluate the reproducibility of the morphologic criteria through a concordance study among three pathologists. Representative slides of 40 patients with biochemically primary HPT stained with hematoxylin and eosin were blindly reviewed by three pathologists. Each pathologist established the diagnosis of adenoma or hyperplasia and assessed the presence of fat cells, a rim of normal tissue, a fibrous capsule, the number of cellular types, the lobular pattern, and the characteristics of the blood vessel's wall. A concordance analysis was then performed. Mean age of the group was 55 +/- 14 yr, 7 were males and 33 females. The concordance analysis among the three pathologists for the differential diagnosis between adenoma and hyperplasia, showed a Kappa index of 0.5. Kappa index for the presence of fat cells was 0.56, for the presence of a rim of normal tissue 0.47, and for the number of cellular types 0.29. The concordance for the differential diagnosis between parathyroid adenoma and hyperplasia in this study was low.
UI - 11479435
AU - Rubello D; Casara D; Dwamena BA; Shapiro B
TI - Parathyroid carcinoma. A concise review.
SO - Minerva Endocrinol 2001 Jun;26(2):59-64
AD - Department of Radiology, University of Michigan Medical Center, Ann Arbor, MI 48109-0028, USA.
Parathyroid carcinoma is a very rare malignancy and the least common among endocrine malignat tumors. Its etiology is still unclear and some hypotheses have been suggested: previous external radiation to the neck, pregression from benign to malignant lesion, familial hyperparathyroidism. An early accurate diagnosis is very important since surgery is the most effective therapeutic approach to parathyroid carcinoma. Prognosis is quite variable and stress is laid on the early diagnosis and radical surgery which seem to be most favorable prognostic factors. An accurate follow-up should include frequent measurements of serum calcium and PTH levels to promptly detect recurrence or metastases which are usually associated with severe hyeprcalcemia.
UI - 11504097
AU - Gabriel M; Erler H; Bacher-Stier C; Kendler D; Donnemiller E;
TI - Decristoforo C; Moncayo R Methodological considerations influence the clinical value of parathyroid localisation diagnostics.
SO - Eur J Nucl Med 2001 Jul;28(7):942-3
UI - 11544565
AU - Katai M; Sakurai A; Ikeo Y; Hashizume K
TI - Primary hyperparathyroidism in patients with multiple endocrine neoplasia type 1: comparison with sporadic parathyroid adenomas.
SO - Horm Metab Res 2001 Aug;33(8):499-503
AD - Department of Aging Medicine and Geriatrics, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
A prospective study on the natural course of primary hyperparathyroidism has recently been reported. Since hyperparathyroidism in multiple endocrine neoplasia type 1 (MEN 1) is genetically distinct from most forms of sporadic hyperparathyroidism, it is important to know the natural course of hyperparathyroidism in MEN 1 for better clinical management. For this purpose, we retrospectively reviewed clinical parameters of patients with MEN 1 when they were diagnosed as having hyperparathyroidism, and compared them with those of patients with sporadic primary hyperparathyroidism. In patients with MEN 1: 1) levels of intact PTH (i-PTH) gradually increased with age, which accelerated over 40 years; 2) compared to the steep rise in i-PTH levels in aged patients, increase in serum calcium or decrease of serum inorganic phosphate concentration was relatively mild, and 3) the high concentrations of i-PTH in aged patients were not due to renal insufficiency. These features were not observed in patients with sporadic primary parathyroid adenomas. Clinical features of untreated hyperparathyroidism in MEN 1 may be significantly affected by the age of the patient. The effect, if any, of age-dependent deterioration on recurrence rate after subtotal or total parathyroidectomy requires further elucidation.
UI - 11564934
AU - Shon IH; Roach PJ; Bernard E; Fulcher G; Delbridge L
TI - Superimposed double parathyroid adenoma on Tc-99m MIBI imaging: the value of oblique images.
SO - Clin Nucl Med 2001 Oct;26(10):876-7
AD - Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia.
UI - 11576946
AU - Imanishi Y; Tahara H
TI - Putative parathyroid tumor suppressor on 1p: independent molecular mechanisms of tumorigenesis from 11q allelic loss.
SO - Am J Kidney Dis 2001 Oct;38(4 Suppl 1):S165-7
AD - Center for Molecular Medicine, University of Connecticut Health Center, Farmington, CT, USA. email@example.com
Multiple endocrine neoplasia type 1 (MEN1) gene was identified to be a tumor suppressor that encodes menin, playing an important role in the development of MEN1-associated tumors. Somatic MEN1 gene mutations also were detected in sporadic non-MEN1 endocrine tumors. Frequent loss of chromosomal arm 1p has been reported in parathyroid adenomas, suggesting the existence of putative tumor-suppressor genes on 1p. In this study, we performed allelotyping of chromosomes 1p and 11q on 60 sporadic parathyroid adenomas. Thirteen of 48 (27%) informative tumors had allelic loss on 1p, and 18 of 50 (36%) had allelic loss on 11q. Ten of 18 tumors with 11q allelic loss successfully completed the sequence of the MEN1 gene coding region and splice junctions, and 3 of 10 (30%) tumors had no somatic mutation, indicating that other putative tumor-suppressor genes on 11q may contribute to their tumorigenesis. Frequency of allelic losses on 1p was significantly higher in tumors without 11q allelic losses (7 of 11 informative tumors [64%]) than in tumors with 11q allelic losses (3 of 17 informative tumors [18%]) by chi-square test (P = 0.0131; chi-square = 6.152). These observations suggested that putative tumor-suppressor genes locate on 1p, and pathways of their tumorigenesis are independent from inactivation of tumor-suppressor genes on 11q.
UI - 11603552
AU - Gupta A; Horattas MC; Moattari AR; Shorten SD
TI - Disseminated brown tumors from hyperparathyroidism masquerading as metastatic cancer: a complication of parathyroid carcinoma.
SO - Am Surg 2001 Oct;67(10):951-5
AD - Department of Surgery, Northeastern Ohio Universities College of Medicine and Akron General Medical Center, 44307, USA.
Osteitis fibrosa cystica (brown tumors) can be a skeletal manifestation of advanced hyperparathyroidism, including parathyroid cancer. Severe osteitis fibrosa cystica can mimic metastatic bone diseases especially in patients with a history of cancer. Because the treatment and prognosis of these two problems differ greatly considering hyperparathyroidism in the differential diagnosis of patients found to have osteolytic lesions is critical for the appropriate management of these patients. In this case report we describe a patient with a history of renal cell cancer and presumed osteolytic bone metastases. During prophylactic intramedullary rodding to prevent pathologic fracture of her femur she was found to have a benign lesion related to her previously undiagnosed hyperparathyroidism caused by an underlying parathyroid cancer. A detailed review of this disease and the associated bone changes is also included to underscore the importance of an adequate differential diagnosis as well as optimal management. Patients with hypercalcemia or bony lesions should not automatically be treated palliatively for metastatic disease just because of a past medical history of cancer. Hyperparathyroidism is a readily curable problem if properly diagnosed.
UI - 11675306
AU - Bennedbaek FN; Karstrup S; Hegedus L
TI - Ultrasound guided laser ablation of a parathyroid adenoma.
SO - Br J Radiol 2001 Oct;74(886):905-7
AD - Department of Endocrinology, Odense University Hospital, DK-5000 Odense C, Denmark.
We present a case of primary hyperparathyroidism with severe hypercalcaemia, treated successfully with ultrasound (US) guided percutaneous interstitial laser photocoagulation (ILP) of a single parathyroid tumour. To our knowledge, this is the first reported case of ILP applied in primary hyperparathyroidism. US guided thermic tissue coagulation with ILP may be a non-surgical alternative in patients with symptomatic hypercalcaemia due to a parathyroid tumour when surgery is contraindicated.
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. firstname.lastname@example.org
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.
UI - 11680967
AU - Marin L; Avalos N; Valenzuela MA; Morales B
TI - [Radioguided surgery of hyperparathyroidism. A case report.]
SO - Rev Med Chil 2001 Aug;129(8):921-4
AD - Servicio de Cirugia y Oncologia, Servicio de Medicina y Endocrinologia, Servicio de Medicina Nuclear. Hospital Clinico de la Fuerza Aerea de Chile General Dr. Raul Yazigi, Santiago de Chile.
Primary hyperparathyroidism is the main cause of hypercalcemia in ambulatory patients. Classic surgical resolution of this disease includes bilateral cervical exploration with exhibition of the four parathyroid glands and evaluation of the suspicious gland with a rapid biopsy. We report a 79 years old female with a primary hyperparathyroidism in whom the adenoma causing the disease was located with the help of an intraoperative gamma-probe that detected the zone of higher radiation counting of Tc99m Sestamibi, that was injected preoperatively. The patient was discharged with normal serum calcium and phosphate levels.
UI - 11692597
AU - Yamaguchi S; Kobayashi Y; Tsujikawa K; Noma M; Mori N; Hara T; Takao T;
TI - Takada S; Sugao H; Yoshida S [Usefulness of 99mTc-methoxy-isobutyl-isonitrile scintigraphy for preoperative localization of adenoma in primary hyperparathyroidism]
SO - Hinyokika Kiyo 2001 Sep;47(9):619-23
AD - Department of Urology, Ikeda Municipal Hospital.
We evaluated the usefulness of 99mTc-methoxy-isobutyl-isonitrile (MIBI) dual phase scintigraphy for detecting hyperfunctioning parathyroid adenoma. We retrospectively reviewed 18 hyperparathyroid patients who received MIBI prior to neck exploration and compared the radiological findings of MIBI with ultrasonography (US) and magnetic resonance imaging (MRI). Fifteen patients were studied with MRI, and 17 patients were examined with US. All patients were found to have a solitary parathyroid adenoma histopathologically. MIBI correctly revealed the location of 17 adenomas among 18 confirmed tumors. In our series, there was one false-positive case that was found to have thyroid adenoma. The diagnostic sensitivity of MIBI MRI and US was 94.4%, 80% and 52.5%, respectively. The positive predictive value (PPV) was 94.4% for MIBI, 81.8% for MRI and 92.3% for US. We conclude that MIBI is useful and accurate for the preoperative localization of adenoma in primary hyperparathyroidism.
UI - 11704205
AU - Dahan M; Chang RJ
TI - Pancreatitis secondary to hyperparathyroidism during pregnancy.
SO - Obstet Gynecol 2001 Nov;98(5 Pt 2):923-5
AD - Department of Reproductive Medicine, University of California at San Diego, 92093, USA. email@example.com
BACKGROUND: It has been suggested that magnesium can be used to reduce serum calcium levels seen with hyperparathyroidism during pregnancy, thus reducing maternal and fetal risk. CASE: A young woman presented at 32 weeks' gestation with abdominal pain from pancreatitis caused by hyperparathyroidism from a parathyroid adenoma. She was started on magnesium sulfate tocolysis for preterm labor. During treatment, serum parathyroid hormone was undetectable, but serum calcium and vitamin D-1,25 were elevated. When magnesium was discontinued, her vitamin D-1,25 was suppressed and the parathyroid hormone was elevated. CONCLUSION: For some patients, because of persistent hypercalcemia, magnesium sulfate might not be a viable treatment option for hyperparathyroidism during pregnancy.
UI - 11730217
AU - Sprouse LR 2nd; Roe SM; Kaufman HJ; Williams N
TI - Minimally invasive parathyroidectomy without intraoperative localization.
SO - Am Surg 2001 Nov;67(11):1022-9
AD - Department of Surgery, University of Tennessee College of Medicine, Chattanooga 37403, USA.
Minimally invasive parathyroidectomy (MIP) is gaining popularity as an alternative to traditional bilateral exploration for patients with primary hyperparathyroidism. The success of MIP relies on the ability of preoperative and intraoperative localization studies to guide a directed exploration for resection of a diseased gland. We hypothesize that excellent results can be achieved with MIP when only technetium-99m sestamibi (MIBI) is used for localization. We conducted a prospective analysis of all patients presenting with a biochemical diagnosis of Patients meeting inclusion criteria were given a choice of MIP and directed exploration versus traditional bilateral exploration. Fifty patients chose MIP. Three patients who chose MIP had a negative MIBI, which left 47 patients in the primary study group. The MIBI correctly identified a parathyroid adenoma in 42 patients (89.3%). In two other patients MIBI was inaccurate; however, directed exploration was successfully converted to a bilateral exploration. Overall 44 of 47 (93.6%) patients in the study group were rendered normocalcemic after the initial operation. Three patients experienced persistent hypercalcemia and subsequently underwent successful bilateral exploration. Including those patients choosing a bilateral exploration, a total of 59 positive MIBI scans were evaluated. There were 54 true positives (positive predictive value 91.5%), and if all patients had chosen a MIP 94.9 per cent would have been successfully treated at the initial operation. Mean operative time for MIP was 54.6 minutes, and in 32 patients (68.1%) MIP was performed with local anesthesia and sedation. Twenty-six patients (55.3%) were discharged the same day of the procedure. There were no significant complications in any group analyzed. We conclude that MIP can be successfully performed on the basis of a positive MIBI scan. The present study highlighting many of the advantages of MIP questions the necessity of additional adjuncts such as intraoperative parathyroid hormone measurement and gamma-probe localization.
UI - 11730230
AU - Parel RJ; Bolton JS; Fuhrman GM
TI - An analysis of sestamibi-positive versus -negative patients with primary hyperparathyroidism.
SO - Am Surg 2001 Nov;67(11):1101-4
AD - Department of Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
We performed this study to evaluate two patient groups with primary hyperparathyroidism depending on whether their abnormal gland(s) could be preoperatively imaged with sestamibi. Patients with primary hyperparathyroidism evaluated by preoperative sestamibi examination from ability of sestamibi to localize their disease. Records were reviewed to determine pre- and postoperative biochemical data, weight of the excised glands, and total operating room time. When the sestamibi imaging was positive a minimally invasive parathyroidectomy was performed; however, when sestamibi scanning was negative patients underwent a formal bilateral neck exploration. All 40 patients in the sestamibi-positive group and 17 of 18 patients in the sestamibi-negative group were cured of their primary hyperparathyroidism as a result of surgery. Sestamibi scanning with a minimally invasive parathyroidectomy shortens operating room time and is most effective when adenomas are large. The results of this study suggest that strategies to preoperatively increase the activity of adenomas may improve the sensitivity of sestamibi scan localization of parathyroid adenomas.
UI - 11711701
AU - Ho Shon IA; Roach PJ; Bernard EJ; Delbridge LW
TI - Optimal pinhole techniques for preoperative localization with Tc-99m MIBI for primary hyperparathyroidism.
SO - Clin Nucl Med 2001 Dec;26(12):1002-9
AD - Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia.
PURPOSE: Technetium-99m-labeled 2-methoxyisobutylisonitrile (Tc-99m MIBI) has been used extensively to localize parathyroid adenomas before operation. Imaging techniques vary widely, and the aim of this study was to determine the optimal time of delayed imaging and the value of routine correlative pertechnetate thyroid imaging. MATERIALS AND METHODS: In this study, preoperative parathyroid localization was performed using pinhole anterior and oblique images (15 minutes and 2 and 4 hours after injection) with correlative pertechnetate thyroid images. Ninety-seven patients underwent dual- or triple-phase Tc-99m MIBI imaging and correlative pertechnetate thyroid imaging before surgery. Two nuclear medicine physicians blinded to the surgical findings interpreted all available images and various Tc-99m MIBI image combinations at 15 minutes alone; 15 minutes and 2 hours, 15 minutes and 4 hours; and 15 minutes and 2 and 4 hours each with and without correlative pertechnetate thyroid imaging. RESULTS: Ninety parathyroid adenomas were detected in 86 patients. The optimal results were achieved with 15-minute and 2- and 4-hour Tc-99m-MIBI images, with correlative thyroid scans resulting in a sensitivity rate of 88%. Fifteen-minute and 2-hour Tc-99m-MIBI images and correlative thyroid scans and 15-minute and 4-hour Tc-99m MIBI images and correlative thyroid scans produced similar results (sensitivity rate, 86% and 83%, respectively; P = not significant). Compared with all Tc-99m MIBI image combinations alone, the addition of the routine correlative thyroid scan significantly improved sensitivity and also improved reporter confidence in 45% of studies. CONCLUSIONS: Of the pinhole techniques compared, 15-minute and 2-hour Tc-99m MIBI images with correlative thyroid scanning may be the preferred imaging protocol, because this yields results similar to imaging for as long as 4 hours after injection in a shorter, more logistically acceptable imaging time.
UI - 11711700
AU - Krausz Y; Shiloni E; Bocher M; Agranovicz S; Manos B; Chisin R
TI - Diagnostic dilemmas in parathyroid scintigraphy.
SO - Clin Nucl Med 2001 Dec;26(12):997-1001
AD - Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel. firstname.lastname@example.org
PURPOSE: Tc-99m MIBI scintigraphy can be useful for preoperative localization of parathyroid adenomas, despite its limited sensitivity. To refine interpretation, the authors conducted prospective reviews of the scintigraphic studies of patients with concomitant thyroid nodular disease and revised the false-negative and false-positive results. MATERIALS AND METHODS: Seventy-seven patients with primary hyperparathyroidism, associated with a solitary parathyroid adenoma, underwent dual-phase MIBI scintigraphy with subsequent injection of Tc-99m pertechnetate before surgery. The false-negative and false-positive scintigraphic findings were identified and revised. RESULTS: After surgery, revision of 19 false-negative scans of the total 77 studies led to the demonstration of an adenoma in seven patients. In five of the seven studies, the adenoma had been overlooked as a result of rapid tracer washout. Two additional small focal lesions would have also been identified if subtraction had been used for differences in contour of the MIBI and pertechnetate images. Four studies were interpreted falsely as abnormal, leading to a positive predictive value of 91%; three were associated with thyroid nodular disease. CONCLUSIONS: Differential washout of MIBI from thyroid and parathyroid tissue is not universal. When MIBI is washed out rapidly from parathyroid adenomas, subtraction of a thyroid image should be performed and differences in contour delineated to localize the adenoma accurately. Some, but not all, thyroid lesions account for the false-positive findings.
UI - 11715621
AU - Geissler B; Grober S; Zugel N; Lindemann F
TI - [Radio-guided parathyroidectomy: successful intraoperative parathyroid localization diagnosis with 99mTc-sestamibi in primary and recurrent hyperparathyroidism]
SO - Chirurg 2001 Oct;72(10):1179-85
AD - Klinik fur Allgemein- und Viszeralchirurgie, Klinikum Augsburg.
INTRODUCTION: In addition to ultrasonography, CT scan, MRI and venous sampling, 99mTc-MIBI scintigraphy has gained increasing acceptance in preoperative localization of abnormal parathyroid tissue. The sensitivity of this radionuclide method is 87% in primary (p), 58% in secondary (s), and 75% in recurrent hyperparathyroidism (HPT). This study evaluated the use of intraoperative nuclear mapping in patients with HPT. METHODS: Retrospective analysis was performed in 24 patients with HPT (18 p, 4 s, 2 recurrent) undergoing a technetium-sestamibi-guided neck exploration during an 18-months period. Abnormal parathyroid tissue was localized using an intraoperative gamma probe detector 2 h after application of 700 MBq 99mTc-sestamibi and verified by pathology. RESULTS: Intraoperative nuclear mapping identified 15 of 18 adenomas in patients with pHPT. The target-to-background ratio was 1.3 to 4.1 in these patients compared to 1.0 to 1.2 in undetected adenomas. In 67% of these patients we performed a minimally invasive open parathyroidectomy. In two cases of recurrent HPT the scan-guided detection of ectopic parathyroid tissue was efficient. In contrast, the method was less helpful in four patients with multiglandular disease. CONCLUSION: The intraoperative use of a gamma probe detector is highly effective in identifying parathyroid adenomas in pHPT and recurrent HPT and supports minimally invasive techniques.
UI - 11702569
AU - Adamek S; Libansky P; Schutzner J; Broulik P; Belsan T
TI - [Surgical approach in mediastinal adenomas and parathyroid carcinomas]
SO - Sb Lek 2000;101(4):307-14
AD - III. chirurgicka klinika 1. lekarske fakulty Univerzity Karlovy, Fakultni nemocnice v Motole, V uvalu 84, 150 00 Praha 5, Czech Republic.
The authors performed retrospective analysis of medical records in a group of 176 patients, who underwent surgical treatment of primary hyperparathyroidism. Surgical strategy was the major issue of interest. Cervical collar incision represented a first-choice approach to cervical exploration in most of cases except those, in whom ectopic mediastinal localization have been diagnosed before the operation. Partial sternotomy was the most common option in surgical re-explorations as a second step following failed parathyroid surgery. We conclude that partial sternotomy is necessary further step in patients with primary hyperparathyroidism complicated by malignant hypercalcaemia on condition that the surgeon is not able to reveal adenomas from neck exploration and sternotomy is than performed immediately during the same operation.
UI - 10496523
AU - Koshiishi N; Chong JM; Fukasawa T; Ikeno R; Tanaka A; Kanazawa K; Ogura
TI - M; Ebuchi M; Takizawa T; Funata N; Fukayama M Microsatellite instability and loss of heterozygosity in primary and secondary proliferative lesions of the parathyroid gland.
SO - Lab Invest 1999 Sep;79(9):1051-8
AD - Department of Pathology, Jichi Medical School, Tochigi, Japan.
Clonality and genetic abnormalities were evaluated to characterize proliferative lesions of the parathyroid gland. Fourteen lesions from patients with single-gland proliferation (adenomas [PA]), 6 lesions from patients with multiple-gland proliferation (primary hyperparathyroidism [PHPT]), and 47 lesions from 16 patients with secondary hyperparathyroidism (SHPT) were examined. Based on the X chromatin inactivation pattern, which was revealed by a HUMARA assay of lesions from female patients (n = 34; 24 informative cases), monoclonality was demonstrated in 6 of 10 PA (60%), 2 of 5 PHPT (40%), and 6 of 9 SHPT lesions (14 of 27 lesions, 52%). By PCR analysis using 17 microsatellite markers on eight chromosomes (chromosomes 1, 2, 3, 5, 6, 11, 13, and 17), loss of heterozygosity was sporadically observed in 4 of 14 PA, 3 of 6 PHPT, and 7 of 47 SHPT lesions, in most cases on a single locus of chromosome 11. On the other hand, microsatellite instability was observed more frequently: ie, in six PA, five PHPT, and nine SHPT lesions. The profile of microsatellite instability depended on the type of proliferation: microsatellite instability (MI) seemed to cluster in the region of chromosome 11 in PA. Microsatellite instability on TP53 was observed in 3 of 6 PHPT lesions and in 2 of 47 SHPT lesions but in no PA lesions. Microsatellite instability on Mfd47 was observed in only some cases of SHPT. Although no significant correlation was identified among histologic features, clonality, and genetic abnormalities in cases of primary proliferation, genetic abnormalities were more frequently observed in SHPT lesions that lacked fat tissues. Thus, genetic instability might be important in proliferative disorders of the parathyroid gland, either with or without uremia. However, genetic instability seems to be induced by different mechanisms in the three types of proliferation studied. In SHPT, the absence of fat tissues may indicate that the proliferation is accompanied by genetic changes.
UI - 11595856
AU - Batsakis C; Kalkana C; Ilias I; Panoutsopoulos G; Christakopoulou I
TI - Giant mediastinal parathyroid adenoma in a woman with hypercalcemia.
SO - Clin Nucl Med 2001 Nov;26(11):950-1
AD - Department of Nuclear Medicine, Sotiria Hospital, Athens, Greece.
UI - 11756777
AU - Sakai Y; Koizumi K; Sugitani I; Nakagawa K; Arai M; Utsunomiya J; Muto
TI - T; Fujita R; Kato Y Familial adenomatous polyposis associated with multiple endocrine neoplasia type 1-related tumors and thyroid carcinoma: a case report with clinicopathologic and molecular analyses.
SO - Am J Surg Pathol 2002 Jan;26(1):103-10
AD - Department of Medicine, Cancer Institute Hospital, Tokyo, Japan. email@example.com
We describe a sporadic case with familial adenomatous polyposis, multiple endocrine neoplasia type 1 (MEN1)-related tumors (an endocrine cell tumor of the pancreas and bilateral parathyroid tumors), and a papillary thyroid carcinoma. To clarify how mutations of the adenomatous polyposis coli ( APC ) gene and the MEN1 gene, responsible for familial adenomatous polyposis and MEN1, respectively, might have contributed to tumorigenesis in this case, we studied germline mutations in both genes and loss of heterozygosity at their genetic loci in multiple lesions. In addition, we performed immunohistochemistry for beta-catenin, associated with the function of the APC gene. A germline mutation was found in the APC gene but not in the MEN1 gene. Normal allelic loss at the APC gene locus was observed in bilateral parathyroid tumors. Immunohistochemical staining of beta-catenin demonstrated accumulation in the cytoplasm in addition to membrane staining in all analyzed tumors and a strong nuclear reaction in the endocrine cell tumor of the pancreas. The presence of normal allelic deletions of the APC gene in bilateral parathyroid tumors and nuclear staining of beta-catenin in the pancreatic tumor in addition to the germline mutations suggests that functional loss of the APC gene played an important role not only in familial adenomatous polyposis but also in the MEN1-related tumors in this case.
UI - 11757150
AU - Vanamo R
TI - [There was a tiny crofter's cottage on an island in Saimaa lake]
SO - Duodecim 1998;114(23):2493-4, 2497
AD - Etela-Karjalan keskussairaala Valto Kakelan katu 1 53130 Lappeenranta.
UI - 11742330
AU - Gauger PG; Agarwal G; England BG; Delbridge LW; Matz KA; Wilkinson M;
TI - Robinson BG; Thompson NW Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience.
SO - Surgery 2001 Dec;130(6):1005-10
AD - University of Michigan Department of Surgery, Ann Arbor, MI, USA.
BACKGROUND: We hypothesized that intraoperative parathyroid hormone monitoring (IOPTH) reliably would detect double parathyroid adenomas. METHODS: This was a retrospective study of 20 patients undergoing conventional parathyroidectomy with resection of exactly 2 abnormal glands. Full exploration was performed regardless of IOPTH values, which were measured after anesthetic induction and 5 and 10 minutes following removal of the first abnormal parathyroid gland. Failure to fall below 50% of baseline value by 10 minutes following resection of the first gland indicated the presence of multiglandular disease. RESULTS: All patients were cured. All excised glands were hypercellular on histology. Mean IOPTH values in 9 of the 20 patients with true negative results (noncurative decrease, another gland present) were 66% +/- 7% at 5 minutes and 83% +/- 15% at 10 minutes. The IOPTH values in 11 of the 20 patients with false positive results (curative decrease, another gland present) were 28% +/- 4% at 5 minutes and 18% +/- 2% at 10 minutes. The false positive rate of IOPTH was 55%. CONCLUSIONS: We found that IOPTH failed to reliably detect the presence of double parathyroid adenomas. These data suggest that caution should be exercised when terminating limited parathyroid exploration based on a curative fall in IOPTH values.
UI - 11441469
AU - Ceyssens S; Mortelmans L
TI - Parathyroid imaging: basic principles and KU Leuven experience: MIBI-dual phase versus MIBI/I-123.
SO - Acta Otorhinolaryngol Belg 2001;55(2):103-17
AD - Department of Nuclear Medicine, University Hospitals Leuven.
OBJECTIVE: The aim of our study was to evaluate and compare retrospectively MIBI-dual phase and MIBI/I-123 subtraction scintigraphy for preoperative localisation of hyperfunctioning parathyroid glands. In our department we also attempted to improve the results of the latter method by altering the subtraction technique. SUBJECTS AND METHODOLOGY: Fifty-one patients with hyperparathyroidism underwent preoperative evaluation with radionuclide scanning for the localisation of abnormal parathyroid glands. MIBI-dual phase and MIBI/I-123 subtraction scintigraphy were carried out respectively in fourteen and thirty-seven patients. Anatomopathological findings were used as the gold standard. RESULTS: Topographic identification of the pathological parathyroid glands was correct in 28% for MIBI-dual phase, in 46% for MIBI/I-123 ('old' method) and in 67.5% for MIBI/I-123 ('new' method). Relying on a normal histology of the normal parathyroid glands, there's a specificity of respectively 82.7%, 99% and 96%. CONCLUSION: MIBI/I-123 subtraction scintigraphy is superior to MIBI-dual phase for the preoperative detection and localisation of hyperfunctioning parathyroid tissue, especially when using a gradual subtraction.
UI - 11688767
AU - Knee TS; Drake AJ 3rd; Turton D; Shakir KM
TI - Effect of parathyroid adenoma resection on bone density in primary hyperparathyroidism and osteitis fibrosa cystica.
SO - Orthopedics 2001 Oct;24(10):1000-2
AD - Department of Internal Medicine, National Naval Medical Center, Bethesda, MD 20889-5600, USA.
UI - 11734934
AU - Solbiati L; Osti V; Cova L; Tonolini M
TI - Ultrasound of thyroid, parathyroid glands and neck lymph nodes.
SO - Eur Radiol 2001;11(12):2411-24
AD - Department of Radiology, General Hospital of Busto Arsizio, Piazzale Solaro, 3, 21052 Busto Arsizio (VA), Italy. firstname.lastname@example.org
In the past 15 years high-frequency B-mode sonography and colour-power Doppler have become the most important and most widely employed imaging modalities for the study of the neck, in particular for thyroid gland, parathyroids and lymph nodes. Sonography allows not only the detection but often also the characterization of the diseases of these organs, distinguishing benign from malignant lesions with high sensitivity and specificity, which could be further improved by the employ of ultrasound contrast agents and harmonic imaging. Although no single sonographic criterion is specific for benign or malignant nature of the lesions, the combination of different signs can be markedly helpful to speed up the diagnostic process. Fine-needle aspiration biopsy (FNAB) remains the most accurate modality for the definitive assessment of thyroid gland nodules and of any doubtful case of nodal disease. In association with clinical findings and serum levels of parathormone, FNAB has specificity close to 100% for the characterization of parathyroid adenomas. A combined approach with sonography and FNAB is generally highly effective.
UI - 11083974
AU - Garcia Garcia E; Lopez Moreno MD; Valenzuela Serrano MI; Lopez Siguero
TI - JP [Parathyroid adenoma in pre-school age children]
SO - An Esp Pediatr 2000 Sep;53(3):277-9
AD - Unidad de Endocrinologia Pediatrica. Servicio de Anatomia Patologica. Complejo Hospitalario Carlos Haya. Malaga. EMIGAGA@santandersupernet.com
Primary hyperparathyroidism in children is rare. The neonatal form involves hyperplasia of the parathyroid glands. In older children sporadic forms are usually due to an adenoma and familial forms are generally due to hyperplasia. Adenoma usually presents in adolescents. In the case presented herein, a parathyroid adenoma was excised from an 11-year-old girl with a history of sporadic hypercalcemia from the age of 5.5 years. The disease was discovered in serum chemistry and the patient presented no symptoms or conditions associated with hypercalcemia. Diagnosis was by preoperative imaging studies including 99mTc-sestabimi and surgical intervention stabilized calcium levels. Parathyroid adenoma occurs in pre-school age children and its diagnosis may be delayed because of the absence of symptoms.
UI - 11816519
AU - Ybarra J; Moises J; Torregrosa JV; Madhun ZT; Schumacher OP
TI - [Effects of octreotide on serum and urine electrolytes in a patient with parathyroid carcinoma: clinical case]
SO - Nefrologia 2001 Jul-Aug;21(4):406-10
AD - Unidad de Trasplante Renal Hospital Clinic 08036 Barcelona.
Parathyroid carcinoma (PC) is a rare endocrine tumor whose management is difficult whenever surgery does not achieve complete en bloc resection or recurrence is detected. Medical options (mainly bisphosphonates) are scanty and often associated with toxic side-effects. We present a case report of a patient with recurrent PC after two surgical interventions who was treated with octreotide (SMS-201) taken into account the positive somatostatin staining of the specimen obtained during the last surgery. Short term effects (-2 weeks-) included a decrease in urinary calcium excretion paired with a simultaneous increase in urinary phosphorus excretion. Later on, continuous subcutaneous octreotide administration kept urinary calcium excretion at low levels and this effect was completely reversible/reinducible upon discontinuation/reintroduction of the drug. Neither iPTH nor total serum calcium were modified at short or long term basis. The lack of clear-cut therapeutic effects make this findings a pure clinical observation. Thus, octreotide cannot be recommended for the treatment of parathyroid carcinoma.
UI - 11722090
AU - Ott MC; Malthaner RA; Reid R
TI - Intraoperative radioguided thoracoscopic removal of ectopic parathyroid adenoma.
SO - Ann Thorac Surg 2001 Nov;72(5):1758-60
AD - Department of Nuclear Medicine, London Health Sciences Centre, University of Western Ontario, Canada.
Twenty-five percent of primary hyperparathyroidism is caused by ectopic mediastinal parathyroid glands, with 2% of these not accessible to standard cervical surgical approaches. Advancement in video-assisted thoracoscopic surgical techniques has decreased the need for sternotomy to successfully remove these ectopic glands. The thoracoscopic approach, however, is limited by the surgeon's inability to always accurately visualize ectopic glands. Intraoperative radionuclide-guided dissection, using a thoracoscopic approach, provides a novel adjunct to the removal of occult ectopic parathyroid glands. We report a case of an occult ectopic parathyroid adenoma removed thoracoscopically using an intraoperative handheld gamma probe.
UI - 11741745
AU - Tanaka C; Uchino S; Noguchi S; Nishioka T; Yamasaki H; Hashimoto K;
TI - Yoshimoto K Biallelic inactivation by somatic mutations of the MEN1 gene in sporadic parathyroid tumors.
SO - Cancer Lett 2002 Jan 25;175(2):175-9
AD - Otsuka Department of Molecular Nutrition, School of Medicine, The University of Tokushima, 3-18-15 Kuramoto-cho, 770-8503, Tokushima, Japan.
We report three sporadic parathyroid tumors with biallelic inactivation of the multiple endocrine neoplasia type 1 (MEN1) gene. Three parathyroid tumors had two somatic mutations (K119del and 864del8, 363insT and 1767delT, and 508del33 and W341X, respectively). The mutations in both alleles detected by long-range polymerase chain reaction and subcloning in three tumors would likely result in a nonfunctional menin protein in parathyroid glands. These results show that the MEN1 gene is inactivated not only by a combination of somatic mutations and loss of heterozygosity, but also by somatic double mutations located on different alleles. The results directly confirmed the participation of MEN1 in the tumorigenesis of sporadic parathyroid tumors.
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