sodium-pertechnetate-tc-99m and Hyperparathyroidism--Primary

Scintigraphy of the hyperfunctioning parathyroid glands using technetium 99m ((99m)Tc)-methoxyisobutylisonitrile ((99m)Tc-MIBI) is an established and highly sensitive preoperative localization tool whose importance has been further increased by advances in minimally invasive surgery . The goal of the present prospective study was to determine the benefit of optimized imaging in a consistent patient population.. Eighty-four patients with first presentations of primary hyperparathyroidism were investigated with (99m)Tc-MIBI scintigraphy, thyroid scintigraphy, and cervical ultrasonography. The evaluation algorithm consisted of (a) evaluation of the planar images alone, (b) additional evaluation of single-photon emission computed tomography (SPECT), (c) additional evaluation of thyroid gland scintigraphy, and (d) additional evaluation of ultrasound. All patients subsequently underwent parathyroidectomy. The intraoperative and the histologic findings were correlated with the results of the scintigraphic imaging.. The sensitivity of planar parathyroid scintigraphy was 74% and could be increased to 91% by the additional investigations. The difference was statistically significant (p<0.05). At the same time, a small increase in specificity from 96% to 99% was seen.. Prior to minimally invasive treatment of hyperparathyroidism, we recommend combined localization studies consisting of sequential (99m)Tc-MIBI scintigraphy, additional SPECT plus thyroid gland scintigraphy, plus high-resolution cervical ultrasonography.

Topics: Adult; Aged; Female; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Ultrasonography, Doppler, Color

Preoperative parathyroid imaging is inevitable part of focused parathyroid surgery. The aim of our study was assessment of parathyroid scintigraphy diagnostic accuracy regarding to size and metabolic parameters of hyperfunctioning parathyroid tissue.. Parathyroid scintigraphy for suspected primary hyperparathyroidism was performed in 95 patients during years 2015 and 2016. Of them, 75 patients with known clinical outcome (40 underwent surgery, 35 had documented laboratory follow-up) were further retrospectively evaluated. The performance of dual tracer 99mTc-pertechnetate and 99mTc-MIBI subtraction and dual-time-point 99mTc-MIBI imaging with SPECT/CT was analysed. Serum parathyroid hormone (PTH), calcaemia, ionized calcaemia and phosphataemia and ultrasound detected adenoma volume and largest diameter in false negative and true positive findings were compared using Mann-Whitney test.. Sensitivity and specificity of parathyroid scintigraphy was 74.5% and 95.8%, respectively. NPV was 63.8% and PPV 97.4%. Hyperfunctioning parathyroid tissue detectability was almost significantly associated with hypophosphataemia and PTH levels.. Parathyroid scintigraphy provides high sensitivity and superior specificity in parathyroid adenoma location, nevertheless the diagnostic accuracy tends to decline in smaller adenomas and in less metabolically active parathyroid tissue causing only subtle biochemical changes. 18F-Fluorocholine PET/CT or 3D SPECT/CT subtraction should be a reasonable option for those cases.

Topics: Aged; Female; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Glands; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Single Photon Emission Computed Tomography Computed Tomography; Sodium Pertechnetate Tc 99m; Time Factors

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

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia in outpatients. It is more common in females, after menopause, and the prevalence is 1 to 4:1000 in the general population. Patients with PHPT have abnormal regulation of PTH secretion, resulting in elevated serum calcium and inappropriately high or normal PTH in relation to the calcium value. Sporadic PTH-secreting adenoma alone accounts for 90% of cases of PHPT, while multiglandular hyperplasia is more common in familial hyperparathyroidism syndromes (5%) and parathyroid carcinomas represent less than 1% of cases. Only after making sure there is functional autonomy of one or more parathyroid glands, localization imaging tests should be performed to guide a possible surgical procedure. It is important to highlight that these tests have limitations and can yield false-positive and false-negative results. There are cases in which the parathyroid gland is difficult to be located, requiring a combination of imaging methods for pre-operative localization, such as (99m)Tc-pertechnetate, SPECT, SPECT/CT, and US. We describe the case of a 50-year-old female patient diagnosed with PHPT, who underwent a surgical procedure without success, with maintenance of hypercalcemia and hyperparathyroidism. In this case, the hyperfunctioning parathyroid was located in the retrotracheal region only after scintigraphy combined with SPECT/CT were used.

Topics: Female; Humans; Hyperparathyroidism, Primary; Middle Aged; Parathyroid Glands; Predictive Value of Tests; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

The most common etiologic factor of primary hyperparathyroidism is a solitary parathyroid adenoma that might be located in the mediastinum. The mediastinally located ectopic parathyroid adenomas are often out of reach with a cervical incision and require a thoracic approach. We present a case of 55 year-old female patient with a parathyroid adenoma located anterior to the ascending aorta within the thymus resulting in primary hyperparathyroidism. The patient underwent an extended thymectomy with intraoperative use of a gamma probe as an adjunct to surgical resection which provided the accurate localization of the parathyroid adenoma. Histologic diagnosis confirmed the tumor to be an ectopic parathyroid adenoma. The patient showed an uneventful postoperative period with decreased levels of both calcium and parathyroid hormone. We emphasize that the gamma probe serves as a very useful device to differentiate the ectopic parathyroid adenoma from surrounding tissues for complete surgical excision.

Topics: Adenoma; Choristoma; Female; Humans; Hyperparathyroidism, Primary; Mediastinal Diseases; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Treatment Outcome