A 34-year-old man with hypercalcemia had a sestamibi scan that showed increased uptake that appeared to correspond with a 7 mm density in the mediastinum, adjacent to the aortic arch, on chest CT. This lesion was thought to be consistent with an ectopic parathyroid adenoma. Prior to surgical exploration, the patient was injected intravenously with 12.3 millicuries of Tc99m-sestamibi. The lesion identified preoperatively did not show abnormal radionuclide uptake using the intraoperative gamma probe, and was subsequently determined to be a hyperplastic lymph node. However, abnormal activity was localized to the thymus gland, from which an ectopic parathyroid adenoma was successfully excised. The patient recovered without incident. The use of the intraoperative gamma probe was critical in identifying and resecting the ectopic parathyroid adenoma in this patient, and in general, may reduce surgical time and reduce the morbidity and/or complications associated with surgical exploration.
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http://dx.doi.org/10.2484/rcr.v3i1.161 | DOI Listing |
Best Pract Res Clin Endocrinol Metab
March 2025
Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada. Electronic address:
Persistent and recurrent primary hyperparathyroidism (PHPT) represent significant challenges in the management of PHPT. Persistent PHPT is defined as persistence of hypercalcemia following parathyroidectomy (PTX) or the recurrence of hypercalcemia within the first 6 months following surgery. Recurrent PHPT is defined as recurrence of hypercalcemia after 6 months following PTX and requires normalization of serum calcium prior to the recurrence.
View Article and Find Full Text PDFIndian J Otolaryngol Head Neck Surg
February 2025
Department of Surgery, Command Hospital Air Force Bangalore, Bangalore, Karnataka 560007 India.
Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease patients, necessitating effective management to prevent adverse outcomes. This study evaluates the efficacy of surgical intervention in achieving biochemical balance in SHPT patients resistant to medical therapy. The study includes 36 patients with SHPT who underwent subtotal parathyroidectomy following failed medical management.
View Article and Find Full Text PDFEctopic mediastinal parathyroid adenoma is rare and is generally managed by surgical resection as a definitive treatment. Intraoperative parathyroid hormone (ioPTH) monitoring is valuable for ensuring the complete removal of a target lesion. However, there is no consensus criteria regarding the utilization of ioPTH for complete resection in patients with ectopic mediastinal parathyroid adenomas.
View Article and Find Full Text PDFFront Endocrinol (Lausanne)
March 2025
Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder, typically caused by a single parathyroid adenoma. The diagnosis of PHPT is biochemical, and the localization of abnormal parathyroid glands is usually achieved through a combination of ultrasound and technetium-99m sestamibi (99mTc-MIBI) scans. In some cases, newer imaging modalities, such as positron emission tomography-computed tomography (PET-CT) with 18F-fluorocholine or 11C-methionine, are used as second-line methods.
View Article and Find Full Text PDFAlveolar bone supports and anchors teeth. The parathyroid hormone-related protein (PTHrP) pathway plays a key role in alveolar bone biology. Salt inducible kinases (SIKs) are important downstream regulators of PTH/PTHrP signaling in the appendicular skeleton, where SIK inhibition increases bone formation and trabecular bone mass.
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