Location of parathyroid adenomas by thallium-201 and technetium-99m subtraction scanning.

Young, A. E.; Gaunt, J. I.; Croft, D. N.; Collins, R. E. C.; Wells, C. P.; Coakley, A. J.

doi:10.1136/bmj.286.6375.1384

Cited by 114 publications

(29 citation statements)

References 12 publications

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“…Thallium-technetium subtraction parathyroid scan, a relatively new technique for loacalization of hyperfunctioning parathyroid tissue devel oped by Ferlin et al [15], seems to be very promising. The scan correctly localized hyperfunctioning parathy roid tissue in 89-92% of the cases surgically proven to be adenomatous, carcinomatous, or hyperplastic [15][16][17][18], This test is particularly useful in patients who have undergone previous neck explorations. In our case the thallium-technetium subtraction scan was beneficial, while the information obtained by venous sampling was confusing and did not help in localizing the hyperplastic tissue.…”

Section: Discussionmentioning

confidence: 99%

“…There is controversy about the value of diagnostic methods used in patients with persistent or recurrent hyperparathyroidism [13][14][15][16][17][18], The role of selective ve nous sampling with PTH radioimunoassay in the diag nosis of a fifth gland has not been clarified. This method is of questionable value in measuring concen trations of PTH in the large veins of the mediastinum [11,14], Of interest is that our patient had no signifi cant step-up in PTH levels in the area where the fifth gland was discovered.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Dilemma of an Unsuspected Hyperfunctioning Accessory Parathyroid Gland after Total Parathyroidectomy with Autotransplantation in a Peritoneal Dialysis Patient

Krutak-Krol¹,

Mace²,

Nichols³

et al. 1989

Am J Nephrol

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Persistent or recurrent hyperparathyroidism in patients with chronic renal failure may be a frustrating problem. We report a case history of a peritoneal dialysis patient who underwent total parathyroidectomy with autotransplantation for secondary hyperparathyroidism, developed tertiary hyperparathyroidism, and in an attempt to control hypercalcemia underwent seven partial resections of the autotransplant. Subsequently, a total excision of the parathyroid autograft was performed, but the patient continued to have hyperparathyroidism and unexpectedly was found to have a hyperplastic fifth parathyroid gland identified by thallium-technetium subtraction scan. The fifth gland was removed, and a part was implanted in the right forearm; however, the autoimplant had to be completely removed because of rapidly developing hypercalcemia. Hypercalcemia was controlled, but elevated levels of parathormone persisted. Remaining parathyroid tissue could not be found.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic Dilemma of an Unsuspected Hyperfunctioning Accessory Parathyroid Gland after Total Parathyroidectomy with Autotransplantation in a Peritoneal Dialysis Patient

Krutak-Krol¹,

Mace²,

Nichols³

et al. 1989

Am J Nephrol

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“…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.…”

Section: I/mentioning

confidence: 99%

Parathyroid Detection in Secondary Hyperparathyroidism with¹²³I/^99mTc-Sestamibi Subtraction Single Photon Emission Computed Tomography

Dr¹,

Madera³

et al. 1998

The Journal of Clinical Endocrinology & Metabolism

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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...

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“…Laborato ry examination revealed that he had hypercalcemia of 3.0 mmol/l with unsuppressed plasma parathyroid hormone, and decreased per cent tubular resorption of phosphate as low as 78%. Computed tomo graphic scan and :olTI-99mTc subtraction scintigraphy [18] showed a mass lesion at the left lower pole of the thyroid gland. Since his hyper calcemia was quite symptomatic, subtotal thyro-parathyroidectomy was performed promptly, which immediately normalized the hyper calcemia.…”

Section: Patientmentioning

confidence: 99%

Osmoregulation of Plasma Vasopressin in Three Cases with Adrenal Insufficiency of Diverse Etiologies

Iwasaki

Kondo

Hasegawa³

et al. 1997

Horm Res

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Neurohypophyseal function was studied by hypertonic saline infusion with plasma vasopressin measurement in 3 patients with adrenal insufficiency before and after cortisol replacement. Although each patient had different causes of adrenal insufficiency, all showed impaired water excretion before replacement. The first patient with isolated adrenocorticotropin deficiency had marked hyponatremia and inappropriate vasopressin secretion which was normalized after replacement, indicating vasopressin hypersecretion during hypoadrenocorticism. The second patient had combined anterior and posterior pituitary deficiency due to postpartum hypopituitarism and showed completely absent vasopressin secretion, with her polyuria being masked before cortisol replacement, suggesting a vasopressin-independent intrarenal mechanism of antidiuresis. The third patient with panhypopituitarism due to a pituitary tumor also had preexisting diabetes insipidus with defective vasopressin secretion. In this case, however, plasma vasopressin was found to be elevated when adrenal insufficiency and hyponatremia subsequently developed. Together, these results indicate that vasopressin hypersecretion does occur during adrenal insufficiency, but that the accompanying urinary diluting defect may be attributable either to vasopressin-dependent or to vasopressin-independent mechanisms.

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Location of parathyroid adenomas by thallium-201 and technetium-99m subtraction scanning.

Cited by 114 publications

References 12 publications

Diagnostic Dilemma of an Unsuspected Hyperfunctioning Accessory Parathyroid Gland after Total Parathyroidectomy with Autotransplantation in a Peritoneal Dialysis Patient

Diagnostic Dilemma of an Unsuspected Hyperfunctioning Accessory Parathyroid Gland after Total Parathyroidectomy with Autotransplantation in a Peritoneal Dialysis Patient

Parathyroid Detection in Secondary Hyperparathyroidism with¹²³I/^99mTc-Sestamibi Subtraction Single Photon Emission Computed Tomography

Osmoregulation of Plasma Vasopressin in Three Cases with Adrenal Insufficiency of Diverse Etiologies

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Location of parathyroid adenomas by thallium-201 and technetium-99m subtraction scanning.

Cited by 114 publications

References 12 publications

Diagnostic Dilemma of an Unsuspected Hyperfunctioning Accessory Parathyroid Gland after Total Parathyroidectomy with Autotransplantation in a Peritoneal Dialysis Patient

Diagnostic Dilemma of an Unsuspected Hyperfunctioning Accessory Parathyroid Gland after Total Parathyroidectomy with Autotransplantation in a Peritoneal Dialysis Patient

Parathyroid Detection in Secondary Hyperparathyroidism with123I/99mTc-Sestamibi Subtraction Single Photon Emission Computed Tomography

Osmoregulation of Plasma Vasopressin in Three Cases with Adrenal Insufficiency of Diverse Etiologies

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Parathyroid Detection in Secondary Hyperparathyroidism with¹²³I/^99mTc-Sestamibi Subtraction Single Photon Emission Computed Tomography