Help with parathyroid localization - Forum


Help with parathyroid localization - Ärzteforum

Post#1 »

I've just started my private practice and the local endocrine guys are testing my mettle.

24F, presented with hypercalcemia and elevated PTH (around 60), explored with 4 enlarged glands, 3 removed and one biopsied. Path c/w hyperparathyroidism (no surprise there.) Unfortunately hypercalcemia persisted, with slight elevation in PTH - 35 to 60. Re-explored by a prominent local surgeon - 4th gland excised and transfered to forearm, no other glands identified. Mediastinum explored, nothing in thymus.

Well still has calcium @ 11.5, PTH from 30-50. Urine calcium around 2-300, nothing on workup for MEA, etc.

Peripheral PTH 32 and 34 - i.e., no difference in arm with transplanted tissue.

I was thinking of a Tec99-sestamibi scan. Any other recommendations.


Re: Help with parathyroid localization - Ärzteforum

Post#2 »

Don't Operate without firm diagnosis/localization with guided PTH assays and MRI or other scan showing the lesion. Even then think four times first before using this as your first case. Be careful, you really don't need this "tsuris" (heartbreaking angina-producing trouble) That neck will be concrete.

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Re: Help with parathyroid localization - Ärzteforum

Post#3 »

Several years ago I had a similar daunting case in a 16 year old with high PTH levels. Neck exploration revealed 3 normal glands, and one slightly enlarged gland. Period. I removed the enlarged gland, and because of the minimal change, was not surprised that the serum calcium didn't budge.

Postop localization studies were not helpful. We sent her to NIH, where with more sophisticated studies, they localized and removed the adenoma, which was hiding in a subcarinal location.

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