Appearance of Intrathymic Parathyroid Adenomas on Pinhole Sestamibi Parathyroid Imaging

Oh, Sang Yoon; Kim, Susanne; Eskandar, Yasser; Kim, Dong Wook; Krynyckyi, Borys R.; Macháč, Josef; Inabnet, William B.; Kim, Chun K.

doi:10.1097/01.rlu.0000218540.50708.03

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…[ 12 ] Focal increased activity separated from the lower pole of thyroid on MIBI pinhole images gives a high probability for ectopic parathyroid adenoma to be located in the thymus. [ 14 ] Sestamibi, as a nonspecific tracer that is taken up by mitochondria, may present high uptake in any mitochondria-rich cells. Thus, mitochondrial density is a major factor to determine the retention of 99mTc-MIBI in tissues.…”

Section: Discussionmentioning

confidence: 99%

A case report of mediastinal ectopic parathyroid adenoma presented as parathyroid crisis localized by SPECT/CT

Zhou

Chen

2016

Medicine

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Introduction:Parathyroid crisis due to ectopic parathyroid adenomas can pose diagnostic and management challenges, since it is quite rare in clinical practice.Clinical Findings/Patient Concerns:A 67-year-old Chinese male presented as a parathyroid crisis due to an ectopic mediastinal parathyroid adenoma with his serum calcium and PTH markedly increased in short time. An ultrasonography and computed tomography (CT) scan of the neck did not reveal any parathyroid adenoma. Thoracic CT detected a contrast-enhanced mass in the mediastinum. Although the ectopic location is difficult to appreciate on anterior planar technetium-99m-sestamibi scintigraphy views but has been accurately localized with single photon-emission computed tomography/computed tomography. After fluid resuscitation, loop diuretic, and calcitonin treatment, a thoracoscope surgery was performed. The histopathology of the mediastinal nodule was consistent with a parathyroid adenoma. Hypocalcemia due to hungry bone syndrome occurred after surgery and was resolved quickly with large-dose calcium and calcitriol supplementation. He is asymptomatic and has normal serum calcium and PTH levels on regular follow-up.Diagnoses:The ultrasonography, CT, sestamibi, and single photon-emission computed tomography/computed tomography provide limited sensitivity in the detecting ectopic parathyroid adenomas alone. The combination of these techniques has incremental value in localizing ectopic parathyroid adenomas over either technique alone.Conclusion:Any parathyroid crisis without parathyroid adenoma in the neck should alert physicians to search for ectopic locations through combination of imaging techniques.

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Section: Discussionmentioning

confidence: 99%

A case report of mediastinal ectopic parathyroid adenoma presented as parathyroid crisis localized by SPECT/CT

Zhou

Chen

2016

Medicine

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“…MIBI görüntülemelerinde tiroid alt kutbundan ayrılan fokal aktivitenin artması timusta yerleşmiş ektopik paratiroid adenomu için yüksek bir ihtimal oluşturur. Ayrıca, submandibular tükürük bezi bölgesinde radyoaktivitenin asimetrisi, inmemiş bir adenomun göstergesi olabilir (33,34). USG'nin ektopik adenomların tanımlanması için tek başına duyarlılığı % 27-89 iken, MIBI'nın tek başına% 54-100, çoğunlukla% 80-90'dır (35).…”

Section: Tanıunclassified

Ektopi̇k Parati̇roi̇d Bezleri̇ne Kli̇ni̇k Ve Cerrahi̇ Yaklaşim Clinical and Surgical Approach to Ectopic Paratiroid Glands

Turan

Yazkan

2019

SDÜ Tıp Fakültesi Dergisi

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ÖZET Ektopik paratiroid bezleri, gözden kaçırıldıklarında, persistan veya rekürren hiperparatiroidizmin ortak bir etiyolojisini oluştururlar. Ektopik paratiroid bezleri, embriyogenez sürecinde anormal göçten kaynaklanır ve başarılı bir identifikasyon olmaması paratiroid cerrahisinde başarı eksikliğine neden olabilir. Ektopik inferior paratiroidler anterior mediastende, timus veya tiroid bezinde en sık görülürken, ektopik superior paratiroidler için en sık görülen pozisyon trakeoözofageal oluk ve retro özofageal bölgedir. Boyun ultrasonografisi, 99mTc Sestamibi taraması ve tek foton emisyonlu bilgisayarlı tomografi (SPECT) veya CT (SPECT / CT) ektopik paratiroidlerin tanısal doğruluğunu arttıran görüntüleme yöntemleridir. Paratiroid dokusu için şüpheli bir lezyonun ince iğne aspirasyon sitolojisi ve aspire edilen materyalin paratiroid hormonu ölçümü ektopik bezlerin preoperatif lokalizasyonuna yardımcı olur. Cerrahi inceleme için yaygın alanlar, üst paratiroidler için üst tiroid kutbu, üst tiroid vasküler yapıları ve servikal özofagus, inferior paratiroidler için karotis arter bifurkasyonu ve timustur. Radyografik olarak başarılı lokalizasyondan sonra minimal invaziv paratiroidektomi, postoperatif hızlı parathormon ölçümü ile desteklenerek ektopik paratiroid adenomu olan hastalarda cerrahi sonuçları önemli ölçüde artırmaktadır. Anahtar kelimeler: Ektopik paratiroid, parathormon, primer hiperparatiroidizm ABSTRACT Ectopic parathyroid glands, when missed, form a common etiology of persistent or recurrent hyperparathyroidism. Ectopic parathyroid glands originate from abnormal migration in the embryogenesis process and lack of a successful identification may lead to a lack of success in parathyroid surgery. While ectopic inferior parathyroids are most common in the anterior mediastinum, thymus or thyroid gland, the most common position for ectopic superior parathyroids is the tracheoesophageal groove and the retro esophageal region. Neck ultrasonography, 99mTc Sestamibi scanning and single-photon emission computed tomography (SPECT) or CT (SPECT / CT) are imaging modalities that increase the diagnostic accuracy of ectopic parathyroids. The fine needle aspiration cytology of the suspected lesion for parathyroid tissue and the parathyroid hormone measurement of the aspirated material help preoperative localization of ectopic glands. Common areas for surgery are upper thyroid pole, upper thyroid vascular structures and cervical esophagus for upper parathyroids and bifurcation of the carotid artery and thymus for inferior parathyroids. After radiographic successful localization, minimally invasive parathyroidectomy is supported by postoperative rapid parathyroid hormone measurement, which significantly increases surgical outcomes in patients with ectopic parathyroid adenoma. Key words: Ectopic parathyroid, parathormone, primary hyperparathyroidism

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“…Ectopic parathyroids may be detected with MIBI with almost the same sensitivity as orthotopic adenomas [ 61 ] . Focal increased activity separated from the lower pole of thyroid on MIBI pinhole images gives a high probability for ectopic parathyroid adenoma to be located in the thymus [ 62 ] . Furthermore, asymmetry of radioactivity in the region of the submandibular salivary gland may be indicative of an undescended inferior adenoma and this must be taken into account when evaluating MIBI scans [ 63 ] .…”

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confidence: 99%

Ectopic Parathyroid Glands and their Anatomical, Clinical and Surgical Implications

Noussios

Anagnostis²,

Natsis

2012

Exp Clin Endocrinol Diabetes

146

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Ectopic parathyroid glands result from aberrant migration during early stages of development and lack of successful identification may lead to lack of success in parathyroid surgery. They constitute a common etiology of persistent or recurrent hyperparathyroidism, when they are missed at initial diagnosis. Their prevalence is about 2-43% in anatomical series and up to 16% and 14% in patients with primary and secondary hyperparathyroidism, respectively. Ectopic inferior parathyroids are most frequently found in the anterior mediastinum, in association with the thymus or the thyroid gland, while the most common position for ectopic superior parathyroids is the tracheoesophageal groove and retroesophageal region. Neck ultrasound and 99mTc Sestamibi scan are first-line imaging modalities, although with low sensitivity and specificity. However, their combination with modern techniques, such as single photon emission computed tomography (SPECT) alone or in combination with CT (SPECT/CT) increases their diagnostic accuracy. Fine needle-aspiration cytology of a lesion suspicious for parathyroid tissue and measurement of parathyroid hormone (PTH) in the aspired material further assist to the successful preoperative localization of ectopic glands. Common sites for surgical investigation are the upper thyroid pole and the upper vascular thyroid stalk behind the hypopharynx and cervical esophagus for the superior parathyroids, and the carotid artery bifurcation and the thymic tongue, for the inferior parathyroids. Radioguided minimally invasive parathyroidectomy after successful localization, assisted by rapid PTH measurement postoperatively, significantly improves surgical outcomes in patients with ectopic parathyroid adenomas.

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Appearance of Intrathymic Parathyroid Adenomas on Pinhole Sestamibi Parathyroid Imaging

Abstract: Focal increased activity completely separated from the lower pole of thyroid (regardless of the distance of separation) on sestamibi pinhole images indicates a high probability of intrathymic parathyroid adenoma.

Cited by 6 publications

References 10 publications

A case report of mediastinal ectopic parathyroid adenoma presented as parathyroid crisis localized by SPECT/CT

A case report of mediastinal ectopic parathyroid adenoma presented as parathyroid crisis localized by SPECT/CT

Ektopi̇k Parati̇roi̇d Bezleri̇ne Kli̇ni̇k Ve Cerrahi̇ Yaklaşim Clinical and Surgical Approach to Ectopic Paratiroid Glands

Ectopic Parathyroid Glands and their Anatomical, Clinical and Surgical Implications

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