ACR Appropriateness Criteria® Parathyroid Adenoma

Imaging, Expert Panel on Neurological; Zander, David; Bunch, Paul M.; Policeni, Bruno; Juliano, Amy F.; Carneiro-Pla, Denise; Gule-Monroe, Maria; Hagiwara, Mari; Hoang, Jenny K.; Jain, Vikas; Kim, Lawrence T.; Moonis, Gul; Parsons, Matthew S.; Rath, Tanya J.; Solórzano, Carmen C.; Subramaniam, Rathan M.; Taheri, M. Reza; Thoma, Kate DuChene; Trout, Andrew T.; Zafereo, Mark; Corey, Amanda S.

doi:10.1016/j.jacr.2021.08.013

Cited by 22 publications

(17 citation statements)

References 107 publications

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“…[ 17 ] Cervical ultrasonography is widely used as the initial localization study in patients with PHPT, because it is a low-cost, safe, without radiation exposure and highly sensitive technique. [ 18 ] Normal parathyroid glands have the same echogenicity as the thyroid and thus usually remain unidentified on ultrasonography. Parathyroid adenoma is typically homogenous, hypoechoic, circumscribed, and oval-shaped.…”

Section: Discussionmentioning

confidence: 99%

Parathyroid adenoma presenting as chronic pancreatitis: A case report and literature review

Chen

2022

Medicine

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Background: Most patients with parathyroid adenomas are asymptomatic and rarely present with chronic pancreatitis (CP). Several studies have reported a positive association between primary hyperparathyroidism (PHPT) and pancreatitis. Parathyroidectomy is the definitive treatment for PHPT. IV bisphosphonates can be considered the drug of choice for bridge to surgery.Methods: We reported a 57-year-old female patient was admitted to the emergency room with left upper quadrant abdominal pain and a diagnosis of recurrent pancreatitis. Magnetic Resonance Cholangiopancreatography confirmed the diagnosis of CP. The patient had no common etiology of pancreatitis. Persistent hypercalcemia was noted despite administering intravenous fluids, and Calcitonin. Intravenous Pamidronate, a Bisphosphonate derivative, was also administered. Although calcium levels initially decreased, they were later found to rebound to previous levels.Results: A diagnosis of parathyroid adenoma and PHPT was made based on the elevated parathyroid hormone levels and cervical ultrasonography indicated right inferior parathyroid adenoma. Technetium-99m methoxy-isobutyl-isonitrile scintigraphy revealed a focal hot spot of tracer accumulation at the right lower thyroid bed. The patient underwent right lower parathyroidectomy smoothly and successfully. After right lower parathyroidectomy, she had normal serum calcium levels (9.2 mg/dL) and parathyroid hormone (16.1 pg/mL). There was no recurrent abdominal pain after the operation.Conclusion: CP is a rare manifestation of parathyroid adenoma. When patients with a history of recurrent pancreatitis, without common causes of pancreatitis, present persistent elevated serum calcium levels, PHPT could be suspected.

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Section: Discussionmentioning

confidence: 99%

Parathyroid adenoma presenting as chronic pancreatitis: A case report and literature review

Chen

2022

Medicine

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“…The sensitivity and positive predictive value of these tests are clinically important features. [ 85 ] In these patients, imaging performed before the first surgery can give important clues. If the initial scans are positive for adenoma and even if the adenoma was missed at the first surgery, the patient should undergo new imaging.…”

Section: Localization Studies (Non-invasive and Invasive)mentioning

confidence: 99%

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

Uludağ¹

2023

Sisli Etfal

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Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia and currently the only definitive treatment is surgery. Although the success rate of parathyroidectomy is over 95% in experienced centers, surgical failure is the most common complication today. Persistent HPT (perHPT) is defined as persistence of hypercalcemia after parathyroidectomy or recurrence of hypercalcemia within the first 6 months, and recurrence of hypercalcemia after a normocalcemic period of more than 6 months is defined as recurrent HPT (recHPT). In the literature, perHPT is reported to be 2–22%, and the rate of recHPT is 1–15%. perHPT is often associated with misdiagnosed pathology or inadequate resection of hyperfunctioning parathyroid tissue, recHPT is associated with newly developing pathology from potentially pathologically natural tissue left in situ at the initial surgery. In the pre-operative evaluation, the initial diagnosis of pHPT and the diagnosis of perHPT or rec HPT should be confirmed in patients who are evaluated with a pre-diagnosis (suspect) of perHPT and recHPT. Surgery is recommended if it meets any of the recommendations in surgical guidelines, as in patients with pHPT, and there are no surgical contraindications. The first preoperative localization studies, surgical notes, operation drawings, if any, intraoperative PTH results, pathological results, and post-operative biochemical results of these patients should be examined. Localization studies with preoperative imaging methods should be performed in all patients with perHPT and recHPT with a confirmed diagnosis and surgical indication. The first-stage imaging methods are ultrasonography and Tc99m sestamibi single photon tomography Tc99mMIBI SPECT or hybrid imaging method, which is combined with both single-photon emission computed tomography and computed tomography (SPECT/CT). The combination of USG and sestamibi scintigraphy increases the localization of the pathological gland. In the secondary stage, Four-Dimensional computer tomography (4D-CT) or dynamic 4-dimensional Magnetic Resonance Imaging (4D-MRI) can be applied. It is focused on as a secondary stage imaging method, especially when the lesion cannot be detected by conventional methods. Positron Emission Tomography (PET) and PET/CT examinations with 11C-choline or 18F-fluorocholine are promising imaging modalities. Invasive examinations can rarely be performed in patients in whom suspicious, incompatible or pathological lesion cannot be detected in noninvasive imaging methods. Bilateral jugular vein sampling, selective venous sampling, parathyroid arteriography, imaging-guided fine-needle aspiration biopsy, and parathormone washout are invasive methods.

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“…10,25,27,28 Prior surgical failures, in cases of suspected parathyroid malignancy or in patients undergoing operative treatment for recurrent, secondary or tertiary hyperparathyroidism will likely require multi-modality imaging. 10,[24][25][26]29 The sensitivity and specificity of US for localising parathyroid adenoma reported in the literature vary widely, with the recent American Head and Neck Society Endocrine Surgery Section guidelines reporting a sensitivity of 74-91% and specificity of 73-95%. 27 A 2017 meta-analysis of 12 studies reported a pooled sensitivity for US of 80% and specificity of 77%, while a large 2019 study in 604 patients reported a sensitivity of only 59%.…”

Section: Parathyroid Adenomamentioning

confidence: 99%

“…The preferred imaging modality for localisation is dependent on local expertise and availability 24 . US is widely recommended as the initial imaging study for localisation, being cost effective and having the added benefit of simultaneous assessment for coexistent thyroid disease 10,24–27 . With equivocal US findings, when used in combination with four‐dimensional computed tomography (4D‐CT) techniques or sestamibi imaging, a high sensitivity and accuracy of localisation is frequently achieved (Fig.…”

Section: Introductionmentioning

confidence: 99%

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Lessons learnt from the global iodinated contrast media shortage in head and neck imaging

et al. 2022

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A recent shortage in the global supply of iodinated contrast media (ICM) has required health service providers to review their contrast administration policies and implement strategies to conserve inventory. This article will review the current best practices in head and neck imaging for a variety of common presentations and provide examples where alternative imaging can be considered due to the recent ICM shortage. Ultrasound and MRI techniques can feature heavily in many diagnostic processes in head and neck pathology, and a variety of common presentations can be appropriately investigated through clinical evaluation or naso-endoscopy. In many instances, for the routine assessment of non-acute adult and paediatric head and neck presentations, the use of contrast-enhanced CT can be safely minimised to conserve ICM if required.

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ACR Appropriateness Criteria® Parathyroid Adenoma

Cited by 22 publications

References 107 publications

Parathyroid adenoma presenting as chronic pancreatitis: A case report and literature review

Parathyroid adenoma presenting as chronic pancreatitis: A case report and literature review

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

Lessons learnt from the global iodinated contrast media shortage in head and neck imaging

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