A rare cause of persistent hyperparathyroidism

Iconaru, Laura; Spinato, Linda; Duttmann, Ruth; Hambye, Anne-Sophie; Devriendt, Arnaud; Herchuelz, Maxime; Mathey, Celine; Karmali, Rafik; Bergmann, Pierre

doi:10.1002/ccr3.3568

Cited by 1 publication

(1 citation statement)

References 18 publications

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“…[3] Therefore, other imaging methods are used in the research protocol to locate parathyroid adenomas more precisely. [4] For instance, a case presented by Iconaru et al [5] reported that 18 F-fluorocholine (FCH) positron emission tomography/computed tomography (PET-CT) was useful in localizing an ectopic parathyroid adenoma in the retropharyngeal space, which is a very unusual and elusive location even in ectopic cases.…”

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confidence: 99%

Retropharyngeal Ectopic Parathyroid Adenoma Localized by 18F-Fluorocholine Positron Emission Tomography/Computed Tomography: A Case Report

et al. 2022

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Ectopic parathyroid adenomas of the retropharyngeal space are relatively rare. Herein, we report a case of primary hyperparathyroidism (PHPT) secondary to a retropharyngeal parathyroid adenoma. A 22-year-old woman presented with elevated serum calcium and parathyroid hormone (PTH) levels, revealed during a medical check-up. The patient had a history of ureteral stones and a confirmed low bone mass. Neck 99mTechnetium-sestamibi singlephoton emission computed tomography (CT) and ultrasonography did not reveal any suspicious lesions. There was no evidence of hereditary PHPT based on the results of targeted gene sequencing. Surgical exploration was unsuccessful, and the PHPT persisted after the first surgery. Approximately a year after the failed operation, 18F-fluorocholine (FCH) positron emission tomography/CT (PET-CT) became available, and when performed, it revealed increased uptake in the retropharyngeal space of the right side of the neck. The results of parathyroid venous sampling were concordant with a >2-fold elevation of PTH level in the veins on the right side of the neck compared to the peripheral veins. The 1.8 cm-diameter mass was successfully removed resulting in an 87% reduction in intraoperative PTH level (198.0-26.5 pg/mL). Subsequently, normalizations of calcium and PTH levels were achieved. In summary, ectopic parathyroid adenomas, including retropharyngeal lesions, should also be suspected when investigating an elusive case of PHPT. 18F-FCH PET-CT can be a useful complementary modality for detecting culprit lesions.

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