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56-YEAR-OLD WOMAN WITH ELEVATED CALCIUM AND PARATHYROID HORMONE LEVELS
Authored By: Keith Fischer and Asif Moinuddin.
Patient: 56 year old female
History: HISTORY:
56-year-old woman with elevated calcium and parathyroid hormone levels
Image Size:[small][as-submitted]

Fig. 1
Initial coronal SPECT images

Fig. 2
Initial immediate and 2 hour delayed planar images

Fig. 3
4 months later coronal SPECT images

Fig. 4
At time of second immediate and 2 hour delayed planar images

Fig. 5
Axial image from CT at time of second image
Image Size:[small][as-submitted]

Findings:

RADIOPHARMACEUTICAL: 19.6 mCi Tc-99m sestamibi i.v.

FINDINGS:
There is an intense focus of increased activity inferior to the lower pole of the right lobe of the thyroid gland. This activity persists on delayed images and is highly suspicious for a parathyroid adenoma. A second focus of abnormal uptake inferior to the lower pole of the left thyroid lobe was not described.

DDx: DIFFERENTIAL DIAGNOSIS:
Hypercellular parathyroid, parathyroid adenoma, parathyroid hyperplasia, parathyroid cancer, thyroid adenoma
Diagnosis: Hypercellualr parathyroid gland  was removed from the right side at surgery
General Discussion: FOLLOW-UP:
The patient returns 4 months later, again with elevated calcium levels (11.1 mg/dl). Parathyroid scan was performed and focus of increased activity was seen inferior to the left lower pole of the thyroid gland. Subsequently, a CT examination was performed, which demostrated a second parathyroid adenoma. Surgical exploration was performed and the left lower hypercellular parathyroid gland was removed. Intraoperative PTH went down from 139 pg/mL to 21 pg/mL, 10 minutes after the removal of the gland.
Specific Discussion: Multiple parathyroid adenomas are very uncommon, but were clearly present in this case. Reports vary, but up to 4% of cases may have more than one adenoma*
References:  Surgery: 108:1014-1019, 1990.
Comments:
No comments posted.
Additional Details:

Case Number: 93369Owner(s): Keith Fischer and Asif MoinuddinLast Updated: 02-07-2013
Anatomy: Face and Neck   Pathology: Neoplasm
Modality: Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: panm, parathyroid adenoma, parathyroid hyperplasia, hypercellularACR: 20000.36300

Case has been viewed 36 times.
Certified by Keith Fischer on 01-27-2009

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