Hypercalcemia associated with hyperparathyroidism, a case study
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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
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