Recurrent Parathyroid Adenoma at the Same Site Importance of ROLL

Abstract

Background: Recurrent hyperparathyroidism is defined by the re-appearance of parathyroid hormone (PTH) and high blood calcium levels more than 6 months after successful initial surgery for primary hyperparathyroidism. Many causes are associated with recurrent hyperparathyroidism and one of the main reasons is the presence of parathyroid adenoma. Radio-guided occult lesion localization (ROLL) has emergent role in per-operative localization of pathological lesions. ROLL has established role in breast cancer, axillary and thyroid surgery. ROLL is a valuable addition in parathyroid exploration especially in small sized parathyroid adenomas. ROLL is safe and efficient techniques helping in more accurate lesion centricity. Case presentation A 35 years old female was referred to our Nuclear Medicine department due to recurrently raised Calcium and PTH levels. She had complaints of generalized aches and pains with no visible neck nodule. Her Ultrasound neck showed no abnormal lesion while 99m Tc MIBIscan showed an area of increased radiotracer uptake in the right side of neck. Focused surgical neck exploration was done and a parathyroid adenoma was removed. Conclusions Parathyroid adenoma is a most common cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Parathyroid adenoma is diagnosed by imaging and laboratory studies. One stop management is the surgical removal of 3 and a half removal of parathyroid gland and only sparing half of the gland.