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 ; Osteoclasts ; Osteogenesis ; Parathyroidectomy

Humans ; Parathyroidectomy* ; Renal Dialysis*

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 ; Parathyroidectomy ; Hyperparathyroidism, Primary

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 ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Parathyroidectomy ; Retrospective Studies

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.

Humans ; Hyperparathyroidism, Secondary ; Parathyroidectomy ; Renal Insufficiency

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 ; Parathyroid Neoplasms ; Parathyroidectomy ; Calcium ; Adenoma

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 ; Female ; Humans ; Hypercalcemia ; Parathyroid Neoplasms ; Parathyroidectomy ; Thoracic Cavity

Minimally invasive parathyroidectomy, a new technique for the surgical management of parathyroid disease, is gaining popularity. The smaller incision in the neck results in better cosmetic results and patient satisfaction. Despite a low incidence of complications, the anesthesiologist should be aware and prepared to manage life saving situations. We describe a case of bilateral tension pneumothoraces during minimally invasive parathyroidectomy.
Cosmetics ; Incidence ; Neck ; Parathyroid Diseases ; Parathyroidectomy ; Patient Satisfaction ; Pneumothorax

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 ; Hyperparathyroidism ; Hyperparathyroidism, Secondary* ; Kidney Failure, Chronic ; Korea ; Parathyroidectomy