2.Brown Tumor Shown Flare Phenomenon On Bone Scan After Parathyroidectomy.
Kwang Ho SHIN ; Seol Hoon PARK ; Sora BAEK ; Sun Young CHAE ; Jung Min KOH ; Jae Seung KIM ; Dae Hyuk MOON ; Jin Sook RYU
Nuclear Medicine and Molecular Imaging 2009;43(5):495-498
Brown tumor is the benign bone lesion consists of woven bone and fibrous tissue without matrix, which develop due to chronic excessive osteoclastic activity such as hyperparathyroidism. Usually they appear with normal uptake or occasionally focally increased uptake on bone scan. We present a case with brown tumor shown more increased uptake and more number of lesions on bone scan after parathyroidectomy, and lesser increased uptake on serial bone scans without any other treatment through several months. This finding is thought to be similar to 'flare phenomenon' which is occasionally seen after treatment of metastatic bone lesions of malignant cancer, and may represent curative process of brown tumor with rapid normal bone formation.
Hyperparathyroidism
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Osteoclasts
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Osteogenesis
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Parathyroidectomy
3.Clinical characterization of post-parathyroidectomy patients with primary hyperparathyroidism and the concordance of preoperative localization imaging with histopathology at a tertiary hospital in Manila, Philippines.
Danica FRANCISCO ; Elizabeth PAZ-PACHECO ; Perie ADORABLE-WAGAN
Journal of the ASEAN Federation of Endocrine Societies 2020;35(1):77-84
BACKGROUND: Philippine studies on primary hyperparathyroidism (PHPT) and preoperative localization are scarce, making improvements on detection and recognition particularly difficult.OBJECTIVE: Describe the clinical profile of post-parathyroidectomy PHPT patients at The Medical City (TMC) and assess localization rates and concordance of neck ultrasound (UTZ) and 99mTc-sestamibi scan (MIBI) with surgical histopathologic findings.METHODOLOGY: Retrospective chart review of PHPT Filipino patients who underwent parathyroidectomy at The Medical City from January 2004 to August 2018. Clinical profile and presentations were described and compared with international data. Imaging results were compared with surgical histopathology findings and the level of agreement was determined.RESULTS: Thirty-five patients were analyzed with female predominance (63%) and an average age of 53 years. Our population had more overt manifestations including skeletal abnormalities (51%), renal calculi (49%) and musculoskeletal symptoms (43%) prior to surgery compared to western countries, where symptoms were noted in less than 20%. MIBI had higher rates of detection than UTZ (80% versus 58%) but had similar localization rates (96.4% versus94%). Whe n performed together, given a positive result from either test, a much higher yield (93.8%) was observed. The level of agreement between MIBI and surgery was 72.5% (?=0.54) while UTZ and surgery was 54.1% (?=0.38).CONCLUSION: Our Filipino subjects had predominantly overt symptomatic hyperparathyroidism upon diagnosis prior to surgery as opposed to more asymptomatic surgical patients in western countries. Combining UTZ and MIBI is a more successful preoperative localization approach in our setting than performing either imaging alone, especially in patients with nodular goiter.
Human
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Parathyroidectomy
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Hyperparathyroidism, Primary
4.Minimally Invasive Parathyroidectomy without an Intraoperative i-PTH Test for Patients with Primary Hyperparathyroidism.
Journal of the Korean Surgical Society 2008;75(1):9-14
PURPOSE: The aim of this retrospective study was to analyze the outcomes of minimally invasive parathyroidectomy without an intraoperative i-PTH test for the patients with primary hyperparathyroidism. METHODS: We analyzed a total of 179 patients with sporadic primary hyperparathyroidism and who underwent parathyroidectomy at ASAN Medical Center between February 1996 and September 2007. Minimally invasive parathyroidectomy without an intraoperative i-PTH test was performed in 75 patients under the guidance of a preoperative localization study that suggested the presence of single gland disease. Bilateral exploration was performed in 70 patients and unilateral exploration was performed in 34 patients. RESULTS: The success rate of minimally invasive parathyroidectomy without an intraoperative i-PTH test was 98.7%. Postoperative persistent hyperparathyroidism developed in only 1 patient among the 75 patients. The frequency of postoperatively confirmed single gland disease and multigland disease was 92.8% (166 patients) and 7.2% (13 patients), respectively. However, for most of the patients with multiglandular disease (11/13 cases, 84.5%), the possibility of multiglandular disease could be predicted by a preoperative localization study and these patients were excluded from the candidates for performing minimally invasive parathyroidectomy without an intraoperative i-PTH test. For cases that the preoperative localization study suggested single lesion, the frequency of multiglandular disease in those patients who underwent bilateral exploration was relatively low (2.7%, 1/38 cases). CONCLUSION: Selected patients with primary hyperparathyroidism can be successfully managed with minimally invasive parathyroidectomy and without an intraoperative i-PTH test when the preoperative localization study suggests the presence of single gland disease. However, careful evaluation of the preoperative localization study is mandatory to minimize the failure rate of minimally invasive parathyroidectomy without an intraoperative i-PTH test.
Humans
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Hyperparathyroidism
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Hyperparathyroidism, Primary
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Parathyroidectomy
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Retrospective Studies
5.Tumoral calcinosis in secondary hyperparathyroidism.
Reinzi Luz S. Bautista ; Ramon Antonio B. Lopa ; Arsenio Claro A. Cabungcal ; Anna Pamela C. Dela Cruz ; Tom Edward N. Lo
Philippine Journal of Otolaryngology Head and Neck Surgery 2016;31(1):48-52
OBJECTIVE: To report a case of tumoral calcinosis from secondary hyperparathyroidism and to describe its surgical management.
METHODS:
Design: Case Report
Setting: Tertiary Public University Hospital
Patient: One
RESULTS: A 34-year-old woman presented with progressively-enlarging bilateral upper extremity masses. Diagnostic tests revealed hyperfunctioning parathyroid glands. The patient underwent subtotal parathyroidectomy, right thyroid lobectomy with isthmusectomy, and transcervical thymectomy. Follow-up revealed marked decrease in parathyroid hormone, and progressive resolution of the tumoral calcinosis.
CONCLUSION: Subtotal parathyroidectomy and transcervical thymectomy have a role in the management of tumoral calcinosis, and in this case led to excellent post-operative results. The rare presentation of secondary hyperparathyroidism and intervention in this patient may have potential lessons for future management of similar cases.
Human ; Female ; Adult ; Calcinosis ; Parathyroidectomy ; Thymectomy
7.Giant Parathyroid Adenoma versus Parathyroid Carcinoma: Differentiating two entities
Hazwani Aziz ; Zanariah Hussein
Journal of the ASEAN Federation of Endocrine Societies 2021;36(1):104-107
Giant parathyroid adenoma (GPA) is defined as adenoma larger than 3.5 g. Twenty-one cases of parathyroid mass >3.5 g in patients with primary hyperparathyroidism who underwent parathyroidectomy in Hospital Putrajaya, Malaysia were identified. Most cases presented with nephrolithiasis. Two cases are reported as parathyroid cancer. GPA has significantly higher serum calcium and iPTH levels and can be asymptomatic. Parathyroid carcinoma patients are frequently symptomatic, with large tumors. Differentiating GPA from parathyroid cancer is important as it determines the subsequent surgical intervention.
Hyperparathyroidism
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Parathyroid Neoplasms
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Parathyroidectomy
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Calcium
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Adenoma
8.The Case of Successful Treatment of Severe Hypercalcemia by Percutaneous Ethanol Injection Therapy in a Renal Transplant Recipient with Hyperparathyroidism.
Ho Jung AN ; Su Jin MOON ; Su Hyun KIM ; Ji Young KIM ; Bum Soon CHOI ; Chul Woo YANG ; Yong Soo KIM ; Byung Kee BANG
Korean Journal of Nephrology 2008;27(5):589-593
Severe hypercalcemia due to persistent hyperparathyroidism after kidney transplantation causes serious medical complications. Medical or surgical treatment is recommended to decrease serum calcium level, but percutaneous ethanol injection therapy (PEIT) is an also useful method for patients who are refractory to medical treatment and under poor condition for parathyroidectomy. Here, we report a case of successful PEIT of refractory hypercalcemia in a 62-year old patient after kidney transplantation. This patient underwent PEIT because of poor general condition. Just after PEIT, serum calcium level was normalized and biointact PTH level was markedly decreased without serious complications. He has been followed up for 6 months without recur so far. PEIT may be recommended for treatment of sustained hypercalcemia in kidney-transplant patients who are refractory to medical treatment or in poor condition for surgical treatment.
Calcium
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Ethanol
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Humans
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Hypercalcemia
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Hyperparathyroidism
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Kidney Transplantation
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Parathyroidectomy
;
Transplants
9.2 Cases of Surgical Experience of Secondary Hyperparathyroidism.
Suck Joon HONG ; Soo Kil PARK ; Gyungyub GONG
Korean Journal of Endocrine Surgery 2003;3(1):63-68
Secondary hyperparathyroidism is the condition is which parathyroid hormone(PTH) is over secreted to compensate for a chronically low serum calcium level and chronic renal failure is the most common cause. In 1934, Albreight reported an association between hyperparathyroidism and the chronic renal failure and in 1960, Stanbury first reported subtotal parathyroidectomy for the treatment of secondary hyperparathyroidism. The physiologic mechanism leading to secondary hyperparathyroidism in the chronic renal failure are well known and relatively well controled with medical management, but sometimes may necessitate surgical intervention in medically intractable cases. In Korea, the surgery for secondry hyperparathyroidism is not frequently performed yet as in western countries. We experienced two cases of secondary hyperparathyroidism recently and report its results of subtotal parathyrodiectomy.
Calcium
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Hyperparathyroidism
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Hyperparathyroidism, Secondary*
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Kidney Failure, Chronic
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Korea
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Parathyroidectomy
10.Intra-thoracic Parathyroid Adenomatosis: A Case Report.
Wan Kee KIM ; Dong Kwan KIM ; Se Hoon CHOI ; Hyeong Ryul KIM ; Yong Hee KIM ; Seung Il PARK
The Korean Journal of Thoracic and Cardiovascular Surgery 2013;46(4):302-304
Ectopic mediastinal parathyroid adenomas are rare, but can be life-threatening. Resection is indicated in those cases accompanied by hypercalcemia, especially in young patients. Although most mediastinal parathyroid adenomas can be removed by a cervical approach, a transthoracic approach is needed when the adenoid tissues are located deep within the thoracic cavity. We describe the case of a 37-year-old female who underwent excision of an intrathoracic ectopic parathyroid adenoma after parathyroidectomy four months earlier.
Adenoids
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Female
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Humans
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Hypercalcemia
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Parathyroid Neoplasms
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Parathyroidectomy
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Thoracic Cavity