FDG Uptake in Secondary Parathyroid Hyperplasia

Abstract

A 55-year-old woman had been on long-term hemodialysis. Her intact parathyroid hormone level was extremely high. High serum levels of alkaline phosphates and phosphorus in addition to the elevated parathyroid hormone suggested secondary hyperparathyroidism. Ultrasonographic examination of the neck revealed enlargement of all parathyroid glands. Fluorodeoxyglucose positron emission tomography and computed tomography scanning were performed to detect any malignant lesions. Regional positron emission tomography images showed increased flurodeoxyglucose uptake in the parathyroid glands, except for the right upper gland. Total parathyroidectomy was performed. Histologic examination confirmed hyperplasia of all parathyroid glands.

Secondary Hyperparathyroidism With “Superscan-Like” Hypermetabolic FDG PET/CT Pattern

“…1 A and B, The images (thick arrow) show increased glucose metabolism in the hyperplasic parathyroid glands, a pattern already reported for both hyperplasia and adenoma. 2,3 The diffuse and heterogeneous hypermetabolic pattern on peripheric and axial skeleton seen on A (arrows) correspondS to increased osteoblastic activity induced by the hypersecretion of parathormon with fibrosis involving the marrow and endostal spaces on CT scan. This was particularly visible in the calvaria, mandible, and long bones.…”