fluorocholine and Hypercalcemia

A 54-year-old woman diagnosed with multiple endocrine neoplasia syndrome type 1 and primary hyperparathyroidism underwent total parathyroidectomy with autotransplantation of parathyroid tissue fragments in the right forearm in 1999. Since several years later, follow-up laboratory examinations showed the relapse of hypercalcemia; the patient started cinacalcet therapy. To exclude the presence of hyperfunctioning parathyroid glands in ortotopic or ectopic sites, a PET/CT scan with 18F-fluorocholine was performed. The PET/CT scan excluded the presence of ortotopic and ectopic parathyroid glands but showed a hyperplastic parathyroid fragment in the right forearm, responsible for the patient's persistent hypercalcemia.

Topics: Choline; Female; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Middle Aged; Neoplasm Recurrence, Local; Parathyroid Glands; Positron Emission Tomography Computed Tomography

In this new case of FHH type-3, FCH-PET/CT failed to localize to the hyperplastic parathyroid glands and localized instead to apparently a lymph node. This, together with increased urinary calcium after vitamin D supplementation, led to unnecessary parathyroidectomy. Given the increasingly lower cost of genetic testing and the cost of follow up and unnecessary surgery, it may prudent to include genetic testing for FHH early on in patients with mild PTH-dependent hypercalcemia.

Topics: Adaptor Protein Complex 2; Adaptor Protein Complex sigma Subunits; Adult; Bone Density; Calcium; Choline; Female; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Kidney; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Treatment Outcome