Primary Hyperaparathyroidism due to Cystic Parathyroid Adenoma not Detected on 99mTc-Sestamibi Scan.
- Author:
Ah Reum KHANG
1
;
Eun Ki KIM
;
Eun Young NAM
;
Sun Ju BYEON
;
Jung Hee KIM
;
Jung Hun OHN
;
Eun Shil HONG
;
Hyung Jin CHOI
;
Kyeong Cheon JUNG
;
Myung Whun SUNG
;
Chan Soo SHIN
;
Kyong Soo PARK
;
Seong Yeon KIM
Author Information
- Publication Type:Case Report
- Keywords: Hyperparathyroidism; Parathyroid neoplasms; Technetium Tc 99m sestamibi
- MeSH: Adult; Biopsy, Fine-Needle; Calcium; Humans; Hyperparathyroidism; Hyperparathyroidism, Primary; Leg; Male; Neck; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Positron-Emission Tomography; Technetium Tc 99m Sestamibi; Thyroid Gland
- From:Endocrinology and Metabolism 2012;27(1):83-88
- CountryRepublic of Korea
- Language:English
- Abstract: Parathyroid cysts, which can be divided into functional and non-functional cysts, are rare causes of primary hyperparathyroidism. A technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi) parathyroid scan is a sensitive diagnostic tool for the localization, although it sometimes shows a false-negative result. Here we report a case of presumed cystic parathyroid adenoma based on clinical findings and analysis of cystic fluid with negative findings in a parathyroid scan. A 44-year-old male patient visited the hospital due to leg pain and compressive symptoms (dysphagia, hoarseness) that had started 4-5 months before. His serum calcium level was 14.4 mg/dL and his intact parathyroid hormone (iPTH) had increased to 478.1 pg/mL. On neck computed tomography, a cystic nodule measuring 6.2 cm was detected in the inferior part of the right thyroid gland. Sestamibi uptake for this nodule was not detected on 2-h delayed imaging, and fluorodeoxyglucose positron emission tomography showed only subtle uptake. Fine-needle aspiration was performed and intracystic iPTH had increased to 61,600 pg/mL. Focused parathyroidectomy guided by intraoperative iPTH monitoring led to successful enucleation of the right inferior parathyroid gland. A parathyroid adenoma was confirmed, and his laboratory results had normalized. This study shows that cystic parathyroid adenoma can sometimes be difficult to detect on a 99mTc-sestamibi parathyroid scan.
