No abstract

ABSTRACT123 I/ 99m Tc-sestamibi subtraction single photon emission computed tomography (SPECT) has been proposed to detect hyperplastic parathyroid tissue, but the clinical usefulness of this technique in secondary hyperparathyroidism is uncertain. The purpose of this study was to evaluate preoperative parathyroid localization using 123 I/ 99m Tc-sestamibi subtraction SPECT in patients with renal failure and secondary hyperparathyroidism. Nineteen patients with chronic renal failure and secondary hyperparathyroidism underwent 123 I/ 99m Tc-sestamibi subtraction SPECT imaging preoperatively. None of these patients had undergone previous neck surgery. The location, weight, and histopathological results of all identified parathyroid glands were recorded. Surgery was considered successful in all patients, with resection of a total of 74 hyperplastic parathyroid glands. 123I/ 99m Tc-sestamibi subtraction SPECT correctly identified 57 of these parathyroid glands (77% sensitivity). The mean weight among the true positive glands (n ϭ 57) was 1031 mg (range, 45-7900 mg), and that among the false negative glands (n ϭ 17) was 465 mg (range, 20 -1800 mg). This difference between the mean weights was statistically significant (P ϭ 0.018). There was a positive correlation between parathyroid weight and detectability with 123 I/ 99m Tc-sestamibi subtraction SPECT (Spearman correlation ϭ 0.28; P ϭ 0.0167).123 I/ 99mTc-sestamibi subtraction SPECT is able to correctly localize hyperplastic parathyroid glands in patients with renal failure and secondary hyperparathyroidism, but there is a fairly weak relationship between preoperative detection rate and anatomical parathyroid gland size. (J Clin Endocrinol Metab 83: [3867][3868][3869][3870][3871] 1998) T HE LOCALIZATION of abnormal parathyroid glands can be helpful in planning surgical strategy before neck exploration. For this purpose, several invasive and noninvasive procedures have been tried, mostly in patients with primary hyperparathyroidism, including high resolution ultrasonography, computed tomography, venous sampling, and magnetic resonance imaging (1). Radionuclide procedures have also been used for this purpose. Previously, the most commonly used scintigraphic approach has been a dual isotope procedure combining 201 Tl-thallous chloride with either 99m Tc-pertechnetate or 123 I-labeled sodium iodide (2). More recently, 99m Tc-sestamibi has become a popular substitute for thallium-201 in scintigraphic parathyroid localization studies. As 99m Tc-sestamibi was first described for this use by Coakley et al. (3), the so-called double phase method proposed by Taillefer et al. (4) has gained considerable attention. This method involves imaging at two points in time; initially at 15 min and later at 2-3 h after iv injection of 99m Tc-sestamibi. A positive finding is an area of increased focal uptake that persists on late planar imaging. Sestamibi accumulation in normal thyroid tissue progressively decreases over time, allowing differentiation from abnormal parathyroid tissu...

No abstract

Introduction Immunoglobulin G4-related disease is a fibrous-inflammatory disease characterized by lymphoplasmacytic tissue infiltration of IgG4 positive plasmablasts and small lymphocytes, that may be related to storiform fibrosis, obliterative phlebitis and modestly increased tissue eosinophils. This condition was recently recognized in 2013. It has unknown pathophysiology. The common characteristics shared by the different entities that make up the IgG4-related disease are: raised serum IgG4 levels, alterations in the imaging tests with neoplastic-like swelling of the affected organs, specific histopathological characteristics, and in immunostaining, as well as a good response to treatment with glucocorticoids. Clinical Case A 75-year-old male with a history of Grave's disease with ophthalmopathy, osteopenia, gastroesophageal reflux disease, obstructive sleep apnea, and benign prostatic hypertrophy presented to the clinic after a neck ultrasound and CT neck were ordered for investigation of bilateral "neck lumps". Neck ultrasound was evident for the heterogeneous appearance of submandibular glands and a hypoechoic nodule in the left neck with internal vascularity below the left jaw. CT neck with IV contrast showed evidence of possibly sialadenitis and lobular soft tissue thickening in the inferior aspect of the left submandibular gland measuring approximately 3.5 cm. Surgical pathology report of the left submandibular gland demonstrated a significant increase with IgG and IgG4 plasma cells and CD38 confirmed a dense plasmacytic infiltrate. IN the laboratory, IgG4 was elevated, 462 mg/dL (2-96 mg/dl) Conclusion As with many autoimmune diseases, it is unknown what triggers the Immunoglobulin G4-related disease. Given that the latter has just recently been diagnosed and recognized it is imperative to continue to record and develop data regarding it to better understand it. Multiple endocrine organs could be involved in the pathology of IgG4 related disease. The health care providers need to be cognizant of this condition and the wide variety of manifestations it could have. This disease can be first encountered by any medical field due to the broad spectrum of clinical findings that it could encompass. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.