Abstract
Primary hyperparathyroidism (PHPT) is a relative common medical problem caused by the inappropriate secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The diagnosis is established by serum calcium and PTH levels and once the diagnosis is established imaging studies help localize the hyperfunctioning adenoma in preparation for curative surgery. Until now, the imaging studies most commonly utilized in PHPT are ultrasonography and 99mTc-Sesta-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. However, these studies often fail to localize the adenoma and inappropriately delay patient referral to a potentially curative surgery. We present the case of a 64-year-old female with symptomatic PHPT who had 3 negative 99mTc-Sestamibi Scans over a period of 5 years who eventually had a PET/CT with 11C-Choline that identified a right lower parathyroid adenoma. She underwent a right lower parathyroidectomy and had a successful outcome. We present a review the current imaging techniques used in the management of PHPT including 99mTc-Sesta-MIBI scintigraphy and its limitations and novel use of PET/CT with 11C-Choline and 18F-Choline in this disease and emphasize the fact that, according to current guidelines, failure to localize the adenoma should not delay referral for curative surgery.
Highlights
We present the case of a 64-year-old female with a personal history of melanoma in situ
We present the case of a 64-year-old female with symptomatic PHPT who had 3 negative 99mTc-Sestamibi Scans over a period of 5 years who eventually had a PET/Computed tomography scanning (CT) with 11C-Choline that identified a right lower parathyroid adenoma
We present a review the current imaging techniques used in the management of PHPT including 99mTc-Sesta-MIBI scintigraphy and its limitations and novel use of PET/CT with 11C-Choline and 18F-Choline in this disease and emphasize the fact that, according to current guidelines, failure to localize the adenoma should not delay referral for curative surgery
Summary
We present the case of a 64-year-old female with a personal history of melanoma in situ. Over the course of the following 4 years she underwent multiple laboratory studies confirming the diagnosis of PHPT Her PTH levels gradually rose from 75.4 to 98.7 to 105.6 to 164.0 to 187.3 mg/dl. During this time frame she received treatment with calcium, tibolone, vitamin D supplements, and underwent 2 additional 99mTc-Sestamibi scans that failed to identify a parathyroid adenoma. She developed fatigue, difficult concentration, gastritis, and abdominal pain that was labeled as irritable bowel syndrome. Informed consent was obtained from the patient for this case report
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