sodium-pertechnetate-tc-99m and Hypercalcemia

A 46 year-old female patient presented to the hospital with ongoing and progressively increasing fatigue, severe nausea and vomiting, loss of appetite, constipation, palpitations and somnolence. Laboratory evaluation revealed a severe hypercalcaemia and overt hyperthyroidism. She was diagnosed with primary hyperparathyroidism accompanied by Graves' disease. The patient underwent total thyroidectomy and right inferior parathyroid gland adenoma excision on the 24th day of her admission to the hospital after calcium levels and free thyroid hormone levels were brought to normal ranges. We suggest that a possibility of simultaneous thyrotoxicosis and primary hyperparathyroidism in cases presenting with a hypercalcaemic crisis should be considered.

Topics: Adenoma; Female; Graves Disease; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Thyroidectomy; Ultrasonography

Topics: Adenoma; Aged; Humans; Hypercalcemia; Hyperparathyroidism; Intraoperative Care; Male; Mediastinal Neoplasms; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Reoperation; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium Tc 99m Sestamibi

Topics: Adenoma; Adult; Humans; Hypercalcemia; Male; Mediastinal Neoplasms; Organophosphorus Compounds; Organotechnetium Compounds; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

When mild asymptomatic hypercalcemia occurs in a patient with hyperthyroidism, it may or may not be due to concurrent hyperparathyroidism and at times only the control of the hyperthyroidism will resolve the problem. Moreover, the presence of hyperfunctioning thyroid nodules will interfere with Tl-201/Tc-99m pertechnetate parathyroid scintigraphy. Initial treatment of hyperthyroidism with I-131 in this situation controls hyperthyroidism and permits successful localization of parathyroid adenomas, which may then be excised--a result that was achieved in three cases.

Topics: Adenoma; Adult; Aged; Female; Goiter, Nodular; Humans; Hypercalcemia; Iodine Radioisotopes; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Thyroid Gland

Eighty six consecutive thallium-technetium subtraction parathyroid scans performed over a three year period for hypercalcaemia have been evaluated. Twelve had chronic renal failure, 11 had hypercalcaemia due to non-hyperparathyroid causes and in 10 the imaging study was technically inadequate. The remaining 53 technically adequate studies performed for hypercalcaemia clinically thought to be possibly due to hyperparathyroidism have been analysed. Of 20 (38%) positive scans, 13 came to surgery (10 correctly localized parathyroid adenomas, 2 with multiple gland hyperplasia, and 1 papillary carcinoma of the thyroid). Of 33 (62%) negative scans, 9 had surgical exploration on the basis of strong clinical grounds and all had parathyroid adenomas. Multiple biochemical parameters have been assessed in relation to a positive outcome on scan. The adjusted calcium-phosphate product and the ratio of the adjusted calcium-phosphate product to creatinine (Ca x P/Cr) were both significantly lower in the scan positive group (P less than 0.01). The scan positive group had a significantly higher mean level of PTH (P less than 0.001) and lower mean level of phosphate (P less than 0.001). The present experience shows that parathyroid imaging is useful in localizing parathyroid adenomas in 50% of cases (10 out of 19). This figure is at the lower end of the range of previously published results. It is less effective in demonstrating multiple gland hyperplasia. The decision as to whether to undertake surgical exploration when the scan is negative has been based successfully on clinical judgement. We feel that an analysis of this nature is important, as it gives insights into the practical relevance of parathyroid imaging in the context of routine clinical work.

Topics: Adenoma; Humans; Hypercalcemia; Hyperparathyroidism; Kidney Failure, Chronic; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Phosphates; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Thallium Radioisotopes

A 53-yr-old man with hypercalcemia was referred after an unsuccessful operative attempt to find a parathyroid adenoma. Metabolic evaluation showed relatively suppressed levels of parathyroid hormone with an elevation of serum 1,25-dihydroxyvitamin D. Thallium-technetium dual isotope imaging revealed localized mediastinal thallium uptake. A vascular mediastinal lesion was then demonstrated by arteriography, with subsequent surgical removal of a mass that proved to be lymphocyte predominant Hodgkin's disease. This case is noteworthy for the finding of isolated lymphocyte predominant Hodgkin's disease in the chest, the association of elevated serum 1,25-dihydroxyvitamin D with hypercalcemia that resolved postoperatively, and the uptake of thallium by the tumor.

Topics: Calcitriol; Calcium; Hodgkin Disease; Humans; Hypercalcemia; Male; Mediastinal Neoplasms; Middle Aged; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium

Parathyroid carcinoma is a slow growing tumor, and the patients most often die from complications to the hypercalcemia. Therefore, any attempt should be made to remove local recurrence and metastasis surgically, as medical treatment is disappointing. A case treated with extensive vascular surgery to the neck is reported.

Topics: Adult; Carcinoma; Carotid Arteries; Humans; Hypercalcemia; Male; Neoplasm Recurrence, Local; Parathyroid Hormone; Parathyroid Neoplasms; Reoperation; Sodium Pertechnetate Tc 99m

Vitamin D intoxication, which may result from zealous intake of health food supplements, may cause metastatic calcification. This is the first reported case of a patient with vitamin D intoxication who had massive gastric uptake of [99mTc]MDP, but no lung uptake, with histologic documentation of the metastatic calcification by gastric biopsy. It is probable that the metastatic calcification was a highly metabolic process in this patient since the gastric uptake resolved within 3 wk when serum calcium and phosphate had returned to normal.

Topics: Bone and Bones; Calcinosis; Cholecalciferol; Female; Gastric Mucosa; Humans; Hypercalcemia; Lung; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach; Stomach Diseases; Technetium Tc 99m Medronate