Hypercalcemia associated with hyperparathyroidism, a case study
Main Article Content
Abstract
Primary hyperparathyroidism is the most common cause of hypercalcemia. The majority (95%) of patients with primary hyperparathyroidism (PHPT) are successfully treated by surgery . The most common causes for persistent PHPT are multiglandular disease, four-gland hyperplasia and missed abnormal ectopic parathyroid glands. We describe a case of persistent primary hyperparathyroidism due to the presence of an ectopic parathyroid gland found at the mediastinum. Intraoperative PTH assay and 99mTc-sestamibi scintigraphy may be useful in early diagnosing of persistent PHPT/unsuccessful surgery and localizing ectopic parathyroid gland.
Article Details
Keywords
Hypercalcemia, Hyperparathyroidism, ectopic parathyroid.
References
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10. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19(2):577-583. doi:10.1245/s10434-011-1870-5
11. Ruda JM, Hollenbeak CS, Stack BC. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2005;132(3):359-372. doi:10.1016/j.otohns.2004.10.005
12. Kluijfhout WP, Venkatesh S, Beninato T, et al. Performance of magnetic resonance imaging in the evaluation of first-time and reoperative primary hyperparathyroidism. Surgery. 2016;160(3):747-754. doi:10.1016/j.surg.2016.05.003
13. Kunstman JW, Kirsch JD, Mahajan A, Udelsman R. Parathyroid Localization and Implications for Clinical Management. J Clin Endocrinol Metab. 2013;98(3):902-912. doi:10.1210/jc.2012-3168
14. Kluijfhout WP, Pasternak JD, Beninato T, et al. Diagnostic performance of computed tomography for parathyroid adenoma localization; a systematic review and meta-analysis. Eur J Radiol. 2017;88:117-128. doi:10.1016/j.ejrad.2017.01.004
15. Smith JR, Oates ME. Radionuclide Imaging of the Parathyroid Glands: Patterns, Pearls, and Pitfalls. RadioGraphics. 2004;24(4):1101-1115. doi:10.1148/rg.244035718
16. Yamada T, Ikuno M, Shinjo Y, et al. Selective venous sampling for primary hyperparathyroidism: how to perform an examination and interpret the results with reference to thyroid vein anatomy. Jpn J Radiol. 2017;35(8):409-416. doi:10.1007/s11604-017-0658-3
17. Calò PG, Pisano G, Loi G, et al. Intraoperative parathyroid hormone assay during focused parathyroidectomy: the importance of 20 minutes measurement. BMC Surg. 2013;13(1):36. doi:10.1186/1471-2482-13-36
2. Roy M, Mazeh H, Chen H, Sippel RS. Incidence and Localization of Ectopic Parathyroid Adenomas in Previously Unexplored Patients. World J Surg. 2013;37(1):102-106. doi:10.1007/s00268-012-1773-z
3. Vijayakumar V, Anderson ME. Detection of ectopic parathyroid adenoma by early Tc-99m sestamibi imaging. Ann Nucl Med. 2005;19(2):157-159. doi:10.1007/BF03027396
4. Arora A. A PRACTICAL MANUAL OF Thyroid and Parathyroid Disease. :228.
5. Boggs JE, Irvin GL, Carneiro DM, Molinari AS. The evolution of parathyroidectomy failures. Surgery. 1999;126(6):998-1002; discussion 1002-1003.
6. Mazotas IG, Yen TWF, Doffek K, et al. Persistent/Recurrent Primary Hyperparathyroidism: Does the Number of Abnormal Glands Play a Role? J Surg Res. 2020;246:335-341. doi:10.1016/j.jss.2019.08.007
7. Alhefdhi A, Schneider DF, Sippel R, Chen H. Recurrent and persistence primary hyperparathyroidism occurs more frequently in patients with double adenomas. J Surg Res. 2014;190(1):198-202. doi:10.1016/j.jss.2014.02.024
8. Gouveia S, Rodrigues D, Barros L, et al. Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland - Case report and review. Arq Bras Endocrinol Metabol. 2012;56:393-403. doi:10.1590/S0004-27302012000600009
9. Gough I. Reoperative Parathyroid Surgery: The Importance of Ectopic Location and Multigland Disease. ANZ J Surg. 2006;76(12):1048-1050. doi:10.1111/j.1445-2197.2006.03931.x
10. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19(2):577-583. doi:10.1245/s10434-011-1870-5
11. Ruda JM, Hollenbeak CS, Stack BC. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg. 2005;132(3):359-372. doi:10.1016/j.otohns.2004.10.005
12. Kluijfhout WP, Venkatesh S, Beninato T, et al. Performance of magnetic resonance imaging in the evaluation of first-time and reoperative primary hyperparathyroidism. Surgery. 2016;160(3):747-754. doi:10.1016/j.surg.2016.05.003
13. Kunstman JW, Kirsch JD, Mahajan A, Udelsman R. Parathyroid Localization and Implications for Clinical Management. J Clin Endocrinol Metab. 2013;98(3):902-912. doi:10.1210/jc.2012-3168
14. Kluijfhout WP, Pasternak JD, Beninato T, et al. Diagnostic performance of computed tomography for parathyroid adenoma localization; a systematic review and meta-analysis. Eur J Radiol. 2017;88:117-128. doi:10.1016/j.ejrad.2017.01.004
15. Smith JR, Oates ME. Radionuclide Imaging of the Parathyroid Glands: Patterns, Pearls, and Pitfalls. RadioGraphics. 2004;24(4):1101-1115. doi:10.1148/rg.244035718
16. Yamada T, Ikuno M, Shinjo Y, et al. Selective venous sampling for primary hyperparathyroidism: how to perform an examination and interpret the results with reference to thyroid vein anatomy. Jpn J Radiol. 2017;35(8):409-416. doi:10.1007/s11604-017-0658-3
17. Calò PG, Pisano G, Loi G, et al. Intraoperative parathyroid hormone assay during focused parathyroidectomy: the importance of 20 minutes measurement. BMC Surg. 2013;13(1):36. doi:10.1186/1471-2482-13-36