Table of Contents
1
UI - 11386024
AU - Bednarek-Tupikowska G; Tolloczko T; Tupikowski W; Bogdanska M; Karwacki
TI -
J; Medras M; Milewicz A
Coexistence of parathyroid carcinoma and non-medullary carcinoma of the
thyroid.
SO - Med Sci Monit 2001 May-Jun;7(3):448-56
AD - Department of Endocrinology and Diabetology, Medical University, ul.
Pasteura 4, 50-367 Wroclaw, Poland.
A case of 35-year-old woman with parathyroid cancer is presented. Five
years ago she underwent surgery for follicular thyroid cancer.
Parathyroid cancer was evidenced by palpable, solid, irregularly shaped
cervical tumor 5 cm in diameter. The patient had severe
hyperparathyroidism confirmed by biochemical findings of hypercalcemia
reaching 16 mg%, hypophosphatemia and hyperphosphatasemia. Serum
parathormone level was 23-fold higher than the norm. These findings were
accompanied by polyuria, polidypsia, symptoms of bone damage and renal
calcification. After the surgery the patient's condition improved
significantly despite persistent hyperparathyroidism. The level of
parathormone decreased, but was still 11 times higher than the norm. Two
months after the surgery she noticed a single node on her neck. The
patient was re-operated for recurrence of parathyroid cancer. Serum
parathormone level was then 6-8 times above the norm. Medical treatment
with furosemide, calcitonin and biphosphonate resulted in normalization
of calcemia and phosphatemia. Further management will aim at
localization of foci of hyperactive parathyroid tissue in order to
enable radical reoperation. The case is reported because of rare
occurrence of parathyroid carcinoma as well as because the carcinoma
occurred in a patient who previously had follicular thyroid cancer.
There are no reports of coexistence of these two neoplasms in available
literature.
2
UI - 11456270
AU - Hara H; Igarashi A; Yano Y; Yashiro T; Ueno E; Aiyoshi Y; Ito K; Obara T
TI -
Ultrasonographic features of parathyroid carcinoma.
SO - Endocr J 2001 Apr;48(2):213-7
AD - Department of Surgery, Institute of Clinical Medicine, University of
Tsukuba, Japan.
Although several authors have reported single cases illustrative of some
ultrasonographic characteristic of parathyroid carcinoma, the value of
ultrasonography for diagnosing this entity remains to be determined. The
purpose of our study was to investigate the ultrasonographic features of
parathyroid carcinoma in a large number of cases. We assessed the shape,
contour, echogenicity, and depth-width (DW) ratio of 16 parathyroid
carcinomas and 61 parathyroid adenomas. Ultrasonography showed that
parathyroid carcinomas tend to be large, inhomogeneous, hypoechoic
masses with lobulated contours. In contrast, parathyroid adenomas were
small, homogeneous, hypoechoic masses with smooth borders. The mean
(range) DW ratios for parathyroid carcinomas were 1.21 (0.91-2.5) and
0.64 (0.33-1.47) for adenomas; the difference was statistically
significant (p<0.0001). The DW ratio was > or =1 in 15 (94%) of the 16
cases of carcinoma, whereas only 3 (5%) of the 61 adenomas had a similar
ratio. Ultrasonographic examination is useful not only for preoperative
localization but also for differentiating parathyroid carcinoma from
adenoma. Parathyroid tumors with irregular margins, inhomogeneous
echogenicity, and a DW ratio > or =1 are likely to be malignant.
3
UI - 11478268
AU - Bornstein-Quevedo L; Gamboa-Dominguez A; Angeles-Angeles A;
TI -
Reyes-Gutierrez E; Vargas-Vorackova F; Gamino R; Herrera MF
Histologic diagnosis of primary hyperparathyroidism: a concordance
analysis between three pathologists.
SO - Endocr Pathol 2001 Spring;12(1):49-54
AD - Department of Pathology, Instituto Nacional de Ciencias Medicas y
Nutricion Salvador Zubiran, Mexico City, Mexico.
Primary hyperparathyroidism (HPT) is caused by a parathyroid adenoma,
hyperplasia or carcinoma. Difficulties for the histologic diagnosis of
abnormal parathyroid tissue are widely recognized. The aim of the study
was to evaluate the reproducibility of the morphologic criteria through
a concordance study among three pathologists. Representative slides of
40 patients with biochemically primary HPT stained with hematoxylin and
eosin were blindly reviewed by three pathologists. Each pathologist
established the diagnosis of adenoma or hyperplasia and assessed the
presence of fat cells, a rim of normal tissue, a fibrous capsule, the
number of cellular types, the lobular pattern, and the characteristics
of the blood vessel's wall. A concordance analysis was then performed.
Mean age of the group was 55 +/- 14 yr, 7 were males and 33 females. The
concordance analysis among the three pathologists for the differential
diagnosis between adenoma and hyperplasia, showed a Kappa index of 0.5.
Kappa index for the presence of fat cells was 0.56, for the presence of
a rim of normal tissue 0.47, and for the number of cellular types 0.29.
The concordance for the differential diagnosis between parathyroid
adenoma and hyperplasia in this study was low.
4
UI - 11479435
AU - Rubello D; Casara D; Dwamena BA; Shapiro B
TI -
Parathyroid carcinoma. A concise review.
SO - Minerva Endocrinol 2001 Jun;26(2):59-64
AD - Department of Radiology, University of Michigan Medical Center, Ann
Arbor, MI 48109-0028, USA.
Parathyroid carcinoma is a very rare malignancy and the least common
among endocrine malignat tumors. Its etiology is still unclear and some
hypotheses have been suggested: previous external radiation to the neck,
pregression from benign to malignant lesion, familial
hyperparathyroidism. An early accurate diagnosis is very important since
surgery is the most effective therapeutic approach to parathyroid
carcinoma. Prognosis is quite variable and stress is laid on the early
diagnosis and radical surgery which seem to be most favorable prognostic
factors. An accurate follow-up should include frequent measurements of
serum calcium and PTH levels to promptly detect recurrence or metastases
which are usually associated with severe hyeprcalcemia.
5
UI - 11504097
AU - Gabriel M; Erler H; Bacher-Stier C; Kendler D; Donnemiller E;
TI -
Decristoforo C; Moncayo R
Methodological considerations influence the clinical value of
parathyroid localisation diagnostics.
SO - Eur J Nucl Med 2001 Jul;28(7):942-3
6
UI - 11544565
AU - Katai M; Sakurai A; Ikeo Y; Hashizume K
TI -
Primary hyperparathyroidism in patients with multiple endocrine
neoplasia type 1: comparison with sporadic parathyroid adenomas.
SO - Horm Metab Res 2001 Aug;33(8):499-503
AD - Department of Aging Medicine and Geriatrics, Shinshu University School
of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan.
A prospective study on the natural course of primary hyperparathyroidism
has recently been reported. Since hyperparathyroidism in multiple
endocrine neoplasia type 1 (MEN 1) is genetically distinct from most
forms of sporadic hyperparathyroidism, it is important to know the
natural course of hyperparathyroidism in MEN 1 for better clinical
management. For this purpose, we retrospectively reviewed clinical
parameters of patients with MEN 1 when they were diagnosed as having
hyperparathyroidism, and compared them with those of patients with
sporadic primary hyperparathyroidism. In patients with MEN 1: 1) levels
of intact PTH (i-PTH) gradually increased with age, which accelerated
over 40 years; 2) compared to the steep rise in i-PTH levels in aged
patients, increase in serum calcium or decrease of serum inorganic
phosphate concentration was relatively mild, and 3) the high
concentrations of i-PTH in aged patients were not due to renal
insufficiency. These features were not observed in patients with
sporadic primary parathyroid adenomas. Clinical features of untreated
hyperparathyroidism in MEN 1 may be significantly affected by the age of
the patient. The effect, if any, of age-dependent deterioration on
recurrence rate after subtotal or total parathyroidectomy requires
further elucidation.
7
UI - 11564934
AU - Shon IH; Roach PJ; Bernard E; Fulcher G; Delbridge L
TI -
Superimposed double parathyroid adenoma on Tc-99m MIBI imaging: the
value of oblique images.
SO - Clin Nucl Med 2001 Oct;26(10):876-7
AD - Department of Nuclear Medicine, Royal North Shore Hospital, Sydney,
Australia.
8
UI - 11576946
AU - Imanishi Y; Tahara H
TI -
Putative parathyroid tumor suppressor on 1p: independent molecular
mechanisms of tumorigenesis from 11q allelic loss.
SO - Am J Kidney Dis 2001 Oct;38(4 Suppl 1):S165-7
AD - Center for Molecular Medicine, University of Connecticut Health Center,
Farmington, CT, USA. imanishi@med.osaka-cu.ac.jp
Multiple endocrine neoplasia type 1 (MEN1) gene was identified to be a
tumor suppressor that encodes menin, playing an important role in the
development of MEN1-associated tumors. Somatic MEN1 gene mutations also
were detected in sporadic non-MEN1 endocrine tumors. Frequent loss of
chromosomal arm 1p has been reported in parathyroid adenomas, suggesting
the existence of putative tumor-suppressor genes on 1p. In this study,
we performed allelotyping of chromosomes 1p and 11q on 60 sporadic
parathyroid adenomas. Thirteen of 48 (27%) informative tumors had
allelic loss on 1p, and 18 of 50 (36%) had allelic loss on 11q. Ten of
18 tumors with 11q allelic loss successfully completed the sequence of
the MEN1 gene coding region and splice junctions, and 3 of 10 (30%)
tumors had no somatic mutation, indicating that other putative
tumor-suppressor genes on 11q may contribute to their tumorigenesis.
Frequency of allelic losses on 1p was significantly higher in tumors
without 11q allelic losses (7 of 11 informative tumors [64%]) than in
tumors with 11q allelic losses (3 of 17 informative tumors [18%]) by
chi-square test (P = 0.0131; chi-square = 6.152). These observations
suggested that putative tumor-suppressor genes locate on 1p, and
pathways of their tumorigenesis are independent from inactivation of
tumor-suppressor genes on 11q.
9
UI - 11603552
AU - Gupta A; Horattas MC; Moattari AR; Shorten SD
TI -
Disseminated brown tumors from hyperparathyroidism masquerading as
metastatic cancer: a complication of parathyroid carcinoma.
SO - Am Surg 2001 Oct;67(10):951-5
AD - Department of Surgery, Northeastern Ohio Universities College of
Medicine and Akron General Medical Center, 44307, USA.
Osteitis fibrosa cystica (brown tumors) can be a skeletal manifestation
of advanced hyperparathyroidism, including parathyroid cancer. Severe
osteitis fibrosa cystica can mimic metastatic bone diseases especially
in patients with a history of cancer. Because the treatment and
prognosis of these two problems differ greatly considering
hyperparathyroidism in the differential diagnosis of patients found to
have osteolytic lesions is critical for the appropriate management of
these patients. In this case report we describe a patient with a history
of renal cell cancer and presumed osteolytic bone metastases. During
prophylactic intramedullary rodding to prevent pathologic fracture of
her femur she was found to have a benign lesion related to her
previously undiagnosed hyperparathyroidism caused by an underlying
parathyroid cancer. A detailed review of this disease and the associated
bone changes is also included to underscore the importance of an
adequate differential diagnosis as well as optimal management. Patients
with hypercalcemia or bony lesions should not automatically be treated
palliatively for metastatic disease just because of a past medical
history of cancer. Hyperparathyroidism is a readily curable problem if
properly diagnosed.
10
UI - 11675306
AU - Bennedbaek FN; Karstrup S; Hegedus L
TI -
Ultrasound guided laser ablation of a parathyroid adenoma.
SO - Br J Radiol 2001 Oct;74(886):905-7
AD - Department of Endocrinology, Odense University Hospital, DK-5000 Odense
C, Denmark.
We present a case of primary hyperparathyroidism with severe
hypercalcaemia, treated successfully with ultrasound (US) guided
percutaneous interstitial laser photocoagulation (ILP) of a single
parathyroid tumour. To our knowledge, this is the first reported case of
ILP applied in primary hyperparathyroidism. US guided thermic tissue
coagulation with ILP may be a non-surgical alternative in patients with
symptomatic hypercalcaemia due to a parathyroid tumour when surgery is
contraindicated.
11
UI - 11680065
AU - Emmelot-Vonk MH; Samson MM; Raymakers JA
TI -
[Cognitive deterioration in elderly due to primary
hyperparathyroidism--resolved by parathyroidectomy]
SO - Ned Tijdschr Geneeskd 2001 Oct 13;145(41):1961-4
AD - Universitair Medisch Centrum, afd. Geriatrie, Postbus 85.500, 3805 GA
Utrecht. m.h.emmelotvonk@digd.azu.nl
Three patients, two women aged 79 and 80 and a man aged 84, showed
symptoms of cognitive impairment caused by primary hyperparathyroidism.
Parathyroidectomy lead to a marked improvement in the symptoms. The
incidence of primary hyperparathyroidism increases with age. Most
patients only show slight symptoms. In addition, clinical symptoms in
elderly patients differ from those in younger patients with mental
changes, general tiredness and reduced muscular strength being
prevalent. In accordance with the literature, which shows high cure
rates with low morbidity and mortality, we recommend that parathyroid
surgery be considered in elderly patients who exhibit only slight or
mental symptoms of primary hyperparathyroidism.
12
UI - 11680967
AU - Marin L; Avalos N; Valenzuela MA; Morales B
TI -
[Radioguided surgery of hyperparathyroidism. A case report.]
SO - Rev Med Chil 2001 Aug;129(8):921-4
AD - Servicio de Cirugia y Oncologia, Servicio de Medicina y Endocrinologia,
Servicio de Medicina Nuclear. Hospital Clinico de la Fuerza Aerea de
Chile General Dr. Raul Yazigi, Santiago de Chile.
Primary hyperparathyroidism is the main cause of hypercalcemia in
ambulatory patients. Classic surgical resolution of this disease
includes bilateral cervical exploration with exhibition of the four
parathyroid glands and evaluation of the suspicious gland with a rapid
biopsy. We report a 79 years old female with a primary
hyperparathyroidism in whom the adenoma causing the disease was located
with the help of an intraoperative gamma-probe that detected the zone of
higher radiation counting of Tc99m Sestamibi, that was injected
preoperatively. The patient was discharged with normal serum calcium and
phosphate levels.
13
UI - 11692597
AU - Yamaguchi S; Kobayashi Y; Tsujikawa K; Noma M; Mori N; Hara T; Takao T;
TI -
Takada S; Sugao H; Yoshida S
[Usefulness of 99mTc-methoxy-isobutyl-isonitrile scintigraphy for
preoperative localization of adenoma in primary hyperparathyroidism]
SO - Hinyokika Kiyo 2001 Sep;47(9):619-23
AD - Department of Urology, Ikeda Municipal Hospital.
We evaluated the usefulness of 99mTc-methoxy-isobutyl-isonitrile (MIBI)
dual phase scintigraphy for detecting hyperfunctioning parathyroid
adenoma. We retrospectively reviewed 18 hyperparathyroid patients who
received MIBI prior to neck exploration and compared the radiological
findings of MIBI with ultrasonography (US) and magnetic resonance
imaging (MRI). Fifteen patients were studied with MRI, and 17 patients
were examined with US. All patients were found to have a solitary
parathyroid adenoma histopathologically. MIBI correctly revealed the
location of 17 adenomas among 18 confirmed tumors. In our series, there
was one false-positive case that was found to have thyroid adenoma. The
diagnostic sensitivity of MIBI MRI and US was 94.4%, 80% and 52.5%,
respectively. The positive predictive value (PPV) was 94.4% for MIBI,
81.8% for MRI and 92.3% for US. We conclude that MIBI is useful and
accurate for the preoperative localization of adenoma in primary
hyperparathyroidism.
14
UI - 11704205
AU - Dahan M; Chang RJ
TI -
Pancreatitis secondary to hyperparathyroidism during pregnancy.
SO - Obstet Gynecol 2001 Nov;98(5 Pt 2):923-5
AD - Department of Reproductive Medicine, University of California at San
Diego, 92093, USA. mhdahan@ucsd.edu
BACKGROUND: It has been suggested that magnesium can be used to reduce
serum calcium levels seen with hyperparathyroidism during pregnancy,
thus reducing maternal and fetal risk. CASE: A young woman presented at
32 weeks' gestation with abdominal pain from pancreatitis caused by
hyperparathyroidism from a parathyroid adenoma. She was started on
magnesium sulfate tocolysis for preterm labor. During treatment, serum
parathyroid hormone was undetectable, but serum calcium and vitamin
D-1,25 were elevated. When magnesium was discontinued, her vitamin
D-1,25 was suppressed and the parathyroid hormone was elevated.
CONCLUSION: For some patients, because of persistent hypercalcemia,
magnesium sulfate might not be a viable treatment option for
hyperparathyroidism during pregnancy.
15
UI - 11730217
AU - Sprouse LR 2nd; Roe SM; Kaufman HJ; Williams N
TI -
Minimally invasive parathyroidectomy without intraoperative
localization.
SO - Am Surg 2001 Nov;67(11):1022-9
AD - Department of Surgery, University of Tennessee College of Medicine,
Chattanooga 37403, USA.
Minimally invasive parathyroidectomy (MIP) is gaining popularity as an
alternative to traditional bilateral exploration for patients with
primary hyperparathyroidism. The success of MIP relies on the ability of
preoperative and intraoperative localization studies to guide a directed
exploration for resection of a diseased gland. We hypothesize that
excellent results can be achieved with MIP when only technetium-99m
sestamibi (MIBI) is used for localization. We conducted a prospective
analysis of all patients presenting with a biochemical diagnosis of
Patients meeting inclusion criteria were given a choice of MIP and
directed exploration versus traditional bilateral exploration. Fifty
patients chose MIP. Three patients who chose MIP had a negative MIBI,
which left 47 patients in the primary study group. The MIBI correctly
identified a parathyroid adenoma in 42 patients (89.3%). In two other
patients MIBI was inaccurate; however, directed exploration was
successfully converted to a bilateral exploration. Overall 44 of 47
(93.6%) patients in the study group were rendered normocalcemic after
the initial operation. Three patients experienced persistent
hypercalcemia and subsequently underwent successful bilateral
exploration. Including those patients choosing a bilateral exploration,
a total of 59 positive MIBI scans were evaluated. There were 54 true
positives (positive predictive value 91.5%), and if all patients had
chosen a MIP 94.9 per cent would have been successfully treated at the
initial operation. Mean operative time for MIP was 54.6 minutes, and in
32 patients (68.1%) MIP was performed with local anesthesia and
sedation. Twenty-six patients (55.3%) were discharged the same day of
the procedure. There were no significant complications in any group
analyzed. We conclude that MIP can be successfully performed on the
basis of a positive MIBI scan. The present study highlighting many of
the advantages of MIP questions the necessity of additional adjuncts
such as intraoperative parathyroid hormone measurement and gamma-probe
localization.
16
UI - 11730230
AU - Parel RJ; Bolton JS; Fuhrman GM
TI -
An analysis of sestamibi-positive versus -negative patients with primary
hyperparathyroidism.
SO - Am Surg 2001 Nov;67(11):1101-4
AD - Department of Surgery, Ochsner Clinic and Alton Ochsner Medical
Foundation, New Orleans, Louisiana 70121, USA.
We performed this study to evaluate two patient groups with primary
hyperparathyroidism depending on whether their abnormal gland(s) could
be preoperatively imaged with sestamibi. Patients with primary
hyperparathyroidism evaluated by preoperative sestamibi examination from
ability of sestamibi to localize their disease. Records were reviewed to
determine pre- and postoperative biochemical data, weight of the excised
glands, and total operating room time. When the sestamibi imaging was
positive a minimally invasive parathyroidectomy was performed; however,
when sestamibi scanning was negative patients underwent a formal
bilateral neck exploration. All 40 patients in the sestamibi-positive
group and 17 of 18 patients in the sestamibi-negative group were cured
of their primary hyperparathyroidism as a result of surgery. Sestamibi
scanning with a minimally invasive parathyroidectomy shortens operating
room time and is most effective when adenomas are large. The results of
this study suggest that strategies to preoperatively increase the
activity of adenomas may improve the sensitivity of sestamibi scan
localization of parathyroid adenomas.
17
UI - 11711701
AU - Ho Shon IA; Roach PJ; Bernard EJ; Delbridge LW
TI -
Optimal pinhole techniques for preoperative localization with Tc-99m
MIBI for primary hyperparathyroidism.
SO - Clin Nucl Med 2001 Dec;26(12):1002-9
AD - Department of Nuclear Medicine, Royal North Shore Hospital, Sydney,
Australia.
PURPOSE: Technetium-99m-labeled 2-methoxyisobutylisonitrile (Tc-99m
MIBI) has been used extensively to localize parathyroid adenomas before
operation. Imaging techniques vary widely, and the aim of this study was
to determine the optimal time of delayed imaging and the value of
routine correlative pertechnetate thyroid imaging. MATERIALS AND
METHODS: In this study, preoperative parathyroid localization was
performed using pinhole anterior and oblique images (15 minutes and 2
and 4 hours after injection) with correlative pertechnetate thyroid
images. Ninety-seven patients underwent dual- or triple-phase Tc-99m
MIBI imaging and correlative pertechnetate thyroid imaging before
surgery. Two nuclear medicine physicians blinded to the surgical
findings interpreted all available images and various Tc-99m MIBI image
combinations at 15 minutes alone; 15 minutes and 2 hours, 15 minutes and
4 hours; and 15 minutes and 2 and 4 hours each with and without
correlative pertechnetate thyroid imaging. RESULTS: Ninety parathyroid
adenomas were detected in 86 patients. The optimal results were achieved
with 15-minute and 2- and 4-hour Tc-99m-MIBI images, with correlative
thyroid scans resulting in a sensitivity rate of 88%. Fifteen-minute and
2-hour Tc-99m-MIBI images and correlative thyroid scans and 15-minute
and 4-hour Tc-99m MIBI images and correlative thyroid scans produced
similar results (sensitivity rate, 86% and 83%, respectively; P = not
significant). Compared with all Tc-99m MIBI image combinations alone,
the addition of the routine correlative thyroid scan significantly
improved sensitivity and also improved reporter confidence in 45% of
studies. CONCLUSIONS: Of the pinhole techniques compared, 15-minute and
2-hour Tc-99m MIBI images with correlative thyroid scanning may be the
preferred imaging protocol, because this yields results similar to
imaging for as long as 4 hours after injection in a shorter, more
logistically acceptable imaging time.
18
UI - 11711700
AU - Krausz Y; Shiloni E; Bocher M; Agranovicz S; Manos B; Chisin R
TI -
Diagnostic dilemmas in parathyroid scintigraphy.
SO - Clin Nucl Med 2001 Dec;26(12):997-1001
AD - Department of Nuclear Medicine, Hadassah University Hospital, Jerusalem,
Israel. yodphat@hadassah.org.il
PURPOSE: Tc-99m MIBI scintigraphy can be useful for preoperative
localization of parathyroid adenomas, despite its limited sensitivity.
To refine interpretation, the authors conducted prospective reviews of
the scintigraphic studies of patients with concomitant thyroid nodular
disease and revised the false-negative and false-positive results.
MATERIALS AND METHODS: Seventy-seven patients with primary
hyperparathyroidism, associated with a solitary parathyroid adenoma,
underwent dual-phase MIBI scintigraphy with subsequent injection of
Tc-99m pertechnetate before surgery. The false-negative and
false-positive scintigraphic findings were identified and revised.
RESULTS: After surgery, revision of 19 false-negative scans of the total
77 studies led to the demonstration of an adenoma in seven patients. In
five of the seven studies, the adenoma had been overlooked as a result
of rapid tracer washout. Two additional small focal lesions would have
also been identified if subtraction had been used for differences in
contour of the MIBI and pertechnetate images. Four studies were
interpreted falsely as abnormal, leading to a positive predictive value
of 91%; three were associated with thyroid nodular disease. CONCLUSIONS:
Differential washout of MIBI from thyroid and parathyroid tissue is not
universal. When MIBI is washed out rapidly from parathyroid adenomas,
subtraction of a thyroid image should be performed and differences in
contour delineated to localize the adenoma accurately. Some, but not
all, thyroid lesions account for the false-positive findings.
19
UI - 11715621
AU - Geissler B; Grober S; Zugel N; Lindemann F
TI -
[Radio-guided parathyroidectomy: successful intraoperative parathyroid
localization diagnosis with 99mTc-sestamibi in primary and recurrent
hyperparathyroidism]
SO - Chirurg 2001 Oct;72(10):1179-85
AD - Klinik fur Allgemein- und Viszeralchirurgie, Klinikum Augsburg.
INTRODUCTION: In addition to ultrasonography, CT scan, MRI and venous
sampling, 99mTc-MIBI scintigraphy has gained increasing acceptance in
preoperative localization of abnormal parathyroid tissue. The
sensitivity of this radionuclide method is 87% in primary (p), 58% in
secondary (s), and 75% in recurrent hyperparathyroidism (HPT). This
study evaluated the use of intraoperative nuclear mapping in patients
with HPT. METHODS: Retrospective analysis was performed in 24 patients
with HPT (18 p, 4 s, 2 recurrent) undergoing a
technetium-sestamibi-guided neck exploration during an 18-months period.
Abnormal parathyroid tissue was localized using an intraoperative gamma
probe detector 2 h after application of 700 MBq 99mTc-sestamibi and
verified by pathology. RESULTS: Intraoperative nuclear mapping
identified 15 of 18 adenomas in patients with pHPT. The
target-to-background ratio was 1.3 to 4.1 in these patients compared to
1.0 to 1.2 in undetected adenomas. In 67% of these patients we performed
a minimally invasive open parathyroidectomy. In two cases of recurrent
HPT the scan-guided detection of ectopic parathyroid tissue was
efficient. In contrast, the method was less helpful in four patients
with multiglandular disease. CONCLUSION: The intraoperative use of a
gamma probe detector is highly effective in identifying parathyroid
adenomas in pHPT and recurrent HPT and supports minimally invasive
techniques.
20
UI - 11702569
AU - Adamek S; Libansky P; Schutzner J; Broulik P; Belsan T
TI -
[Surgical approach in mediastinal adenomas and parathyroid carcinomas]
SO - Sb Lek 2000;101(4):307-14
AD - III. chirurgicka klinika 1. lekarske fakulty Univerzity Karlovy,
Fakultni nemocnice v Motole, V uvalu 84, 150 00 Praha 5, Czech Republic.
The authors performed retrospective analysis of medical records in a
group of 176 patients, who underwent surgical treatment of primary
hyperparathyroidism. Surgical strategy was the major issue of interest.
Cervical collar incision represented a first-choice approach to cervical
exploration in most of cases except those, in whom ectopic mediastinal
localization have been diagnosed before the operation. Partial
sternotomy was the most common option in surgical re-explorations as a
second step following failed parathyroid surgery. We conclude that
partial sternotomy is necessary further step in patients with primary
hyperparathyroidism complicated by malignant hypercalcaemia on condition
that the surgeon is not able to reveal adenomas from neck exploration
and sternotomy is than performed immediately during the same operation.
21
UI - 9204193
AU - Sandelin K
TI -
Parathyroid carcinoma.
SO - Cancer Treat Res 1997;89():183-92
AD - Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
22
UI - 10496523
AU - Koshiishi N; Chong JM; Fukasawa T; Ikeno R; Tanaka A; Kanazawa K; Ogura
TI -
M; Ebuchi M; Takizawa T; Funata N; Fukayama M
Microsatellite instability and loss of heterozygosity in primary and
secondary proliferative lesions of the parathyroid gland.
SO - Lab Invest 1999 Sep;79(9):1051-8
AD - Department of Pathology, Jichi Medical School, Tochigi, Japan.
Clonality and genetic abnormalities were evaluated to characterize
proliferative lesions of the parathyroid gland. Fourteen lesions from
patients with single-gland proliferation (adenomas [PA]), 6 lesions from
patients with multiple-gland proliferation (primary hyperparathyroidism
[PHPT]), and 47 lesions from 16 patients with secondary
hyperparathyroidism (SHPT) were examined. Based on the X chromatin
inactivation pattern, which was revealed by a HUMARA assay of lesions
from female patients (n = 34; 24 informative cases), monoclonality was
demonstrated in 6 of 10 PA (60%), 2 of 5 PHPT (40%), and 6 of 9 SHPT
lesions (14 of 27 lesions, 52%). By PCR analysis using 17 microsatellite
markers on eight chromosomes (chromosomes 1, 2, 3, 5, 6, 11, 13, and
17), loss of heterozygosity was sporadically observed in 4 of 14 PA, 3
of 6 PHPT, and 7 of 47 SHPT lesions, in most cases on a single locus of
chromosome 11. On the other hand, microsatellite instability was
observed more frequently: ie, in six PA, five PHPT, and nine SHPT
lesions. The profile of microsatellite instability depended on the type
of proliferation: microsatellite instability (MI) seemed to cluster in
the region of chromosome 11 in PA. Microsatellite instability on TP53
was observed in 3 of 6 PHPT lesions and in 2 of 47 SHPT lesions but in
no PA lesions. Microsatellite instability on Mfd47 was observed in only
some cases of SHPT. Although no significant correlation was identified
among histologic features, clonality, and genetic abnormalities in cases
of primary proliferation, genetic abnormalities were more frequently
observed in SHPT lesions that lacked fat tissues. Thus, genetic
instability might be important in proliferative disorders of the
parathyroid gland, either with or without uremia. However, genetic
instability seems to be induced by different mechanisms in the three
types of proliferation studied. In SHPT, the absence of fat tissues may
indicate that the proliferation is accompanied by genetic changes.
23
UI - 11595856
AU - Batsakis C; Kalkana C; Ilias I; Panoutsopoulos G; Christakopoulou I
TI -
Giant mediastinal parathyroid adenoma in a woman with hypercalcemia.
SO - Clin Nucl Med 2001 Nov;26(11):950-1
AD - Department of Nuclear Medicine, Sotiria Hospital, Athens, Greece.
24
UI - 11756777
AU - Sakai Y; Koizumi K; Sugitani I; Nakagawa K; Arai M; Utsunomiya J; Muto
TI -
T; Fujita R; Kato Y
Familial adenomatous polyposis associated with multiple endocrine
neoplasia type 1-related tumors and thyroid carcinoma: a case report
with clinicopathologic and molecular analyses.
SO - Am J Surg Pathol 2002 Jan;26(1):103-10
AD - Department of Medicine, Cancer Institute Hospital, Tokyo, Japan.
sakaiy-ind@umin.ac.jp
We describe a sporadic case with familial adenomatous polyposis,
multiple endocrine neoplasia type 1 (MEN1)-related tumors (an endocrine
cell tumor of the pancreas and bilateral parathyroid tumors), and a
papillary thyroid carcinoma. To clarify how mutations of the adenomatous
polyposis coli ( APC ) gene and the MEN1 gene, responsible for familial
adenomatous polyposis and MEN1, respectively, might have contributed to
tumorigenesis in this case, we studied germline mutations in both genes
and loss of heterozygosity at their genetic loci in multiple lesions. In
addition, we performed immunohistochemistry for beta-catenin, associated
with the function of the APC gene. A germline mutation was found in the
APC gene but not in the MEN1 gene. Normal allelic loss at the APC gene
locus was observed in bilateral parathyroid tumors. Immunohistochemical
staining of beta-catenin demonstrated accumulation in the cytoplasm in
addition to membrane staining in all analyzed tumors and a strong
nuclear reaction in the endocrine cell tumor of the pancreas. The
presence of normal allelic deletions of the APC gene in bilateral
parathyroid tumors and nuclear staining of beta-catenin in the
pancreatic tumor in addition to the germline mutations suggests that
functional loss of the APC gene played an important role not only in
familial adenomatous polyposis but also in the MEN1-related tumors in
this case.
25
UI - 11757150
AU - Vanamo R
TI -
[There was a tiny crofter's cottage on an island in Saimaa lake]
SO - Duodecim 1998;114(23):2493-4, 2497
AD - Etela-Karjalan keskussairaala Valto Kakelan katu 1 53130 Lappeenranta.
26
UI - 11742330
AU - Gauger PG; Agarwal G; England BG; Delbridge LW; Matz KA; Wilkinson M;
TI -
Robinson BG; Thompson NW
Intraoperative parathyroid hormone monitoring fails to detect double
parathyroid adenomas: a 2-institution experience.
SO - Surgery 2001 Dec;130(6):1005-10
AD - University of Michigan Department of Surgery, Ann Arbor, MI, USA.
BACKGROUND: We hypothesized that intraoperative parathyroid hormone
monitoring (IOPTH) reliably would detect double parathyroid adenomas.
METHODS: This was a retrospective study of 20 patients undergoing
conventional parathyroidectomy with resection of exactly 2 abnormal
glands. Full exploration was performed regardless of IOPTH values, which
were measured after anesthetic induction and 5 and 10 minutes following
removal of the first abnormal parathyroid gland. Failure to fall below
50% of baseline value by 10 minutes following resection of the first
gland indicated the presence of multiglandular disease. RESULTS: All
patients were cured. All excised glands were hypercellular on histology.
Mean IOPTH values in 9 of the 20 patients with true negative results
(noncurative decrease, another gland present) were 66% +/- 7% at 5
minutes and 83% +/- 15% at 10 minutes. The IOPTH values in 11 of the 20
patients with false positive results (curative decrease, another gland
present) were 28% +/- 4% at 5 minutes and 18% +/- 2% at 10 minutes. The
false positive rate of IOPTH was 55%. CONCLUSIONS: We found that IOPTH
failed to reliably detect the presence of double parathyroid adenomas.
These data suggest that caution should be exercised when terminating
limited parathyroid exploration based on a curative fall in IOPTH
values.
27
UI - 11441469
AU - Ceyssens S; Mortelmans L
TI -
Parathyroid imaging: basic principles and KU Leuven experience:
MIBI-dual phase versus MIBI/I-123.
SO - Acta Otorhinolaryngol Belg 2001;55(2):103-17
AD - Department of Nuclear Medicine, University Hospitals Leuven.
OBJECTIVE: The aim of our study was to evaluate and compare
retrospectively MIBI-dual phase and MIBI/I-123 subtraction scintigraphy
for preoperative localisation of hyperfunctioning parathyroid glands. In
our department we also attempted to improve the results of the latter
method by altering the subtraction technique. SUBJECTS AND METHODOLOGY:
Fifty-one patients with hyperparathyroidism underwent preoperative
evaluation with radionuclide scanning for the localisation of abnormal
parathyroid glands. MIBI-dual phase and MIBI/I-123 subtraction
scintigraphy were carried out respectively in fourteen and thirty-seven
patients. Anatomopathological findings were used as the gold standard.
RESULTS: Topographic identification of the pathological parathyroid
glands was correct in 28% for MIBI-dual phase, in 46% for MIBI/I-123
('old' method) and in 67.5% for MIBI/I-123 ('new' method). Relying on a
normal histology of the normal parathyroid glands, there's a specificity
of respectively 82.7%, 99% and 96%. CONCLUSION: MIBI/I-123 subtraction
scintigraphy is superior to MIBI-dual phase for the preoperative
detection and localisation of hyperfunctioning parathyroid tissue,
especially when using a gradual subtraction.
28
UI - 11688767
AU - Knee TS; Drake AJ 3rd; Turton D; Shakir KM
TI -
Effect of parathyroid adenoma resection on bone density in primary
hyperparathyroidism and osteitis fibrosa cystica.
SO - Orthopedics 2001 Oct;24(10):1000-2
AD - Department of Internal Medicine, National Naval Medical Center,
Bethesda, MD 20889-5600, USA.
29
UI - 11734934
AU - Solbiati L; Osti V; Cova L; Tonolini M
TI -
Ultrasound of thyroid, parathyroid glands and neck lymph nodes.
SO - Eur Radiol 2001;11(12):2411-24
AD - Department of Radiology, General Hospital of Busto Arsizio, Piazzale
Solaro, 3, 21052 Busto Arsizio (VA), Italy. lusolbia@tin.it
In the past 15 years high-frequency B-mode sonography and colour-power
Doppler have become the most important and most widely employed imaging
modalities for the study of the neck, in particular for thyroid gland,
parathyroids and lymph nodes. Sonography allows not only the detection
but often also the characterization of the diseases of these organs,
distinguishing benign from malignant lesions with high sensitivity and
specificity, which could be further improved by the employ of ultrasound
contrast agents and harmonic imaging. Although no single sonographic
criterion is specific for benign or malignant nature of the lesions, the
combination of different signs can be markedly helpful to speed up the
diagnostic process. Fine-needle aspiration biopsy (FNAB) remains the
most accurate modality for the definitive assessment of thyroid gland
nodules and of any doubtful case of nodal disease. In association with
clinical findings and serum levels of parathormone, FNAB has specificity
close to 100% for the characterization of parathyroid adenomas. A
combined approach with sonography and FNAB is generally highly
effective.
30
UI - 11083974
AU - Garcia Garcia E; Lopez Moreno MD; Valenzuela Serrano MI; Lopez Siguero
TI -
JP
[Parathyroid adenoma in pre-school age children]
SO - An Esp Pediatr 2000 Sep;53(3):277-9
AD - Unidad de Endocrinologia Pediatrica. Servicio de Anatomia Patologica.
Complejo Hospitalario Carlos Haya. Malaga. EMIGAGA@santandersupernet.com
Primary hyperparathyroidism in children is rare. The neonatal form
involves hyperplasia of the parathyroid glands. In older children
sporadic forms are usually due to an adenoma and familial forms are
generally due to hyperplasia. Adenoma usually presents in adolescents.
In the case presented herein, a parathyroid adenoma was excised from an
11-year-old girl with a history of sporadic hypercalcemia from the age
of 5.5 years. The disease was discovered in serum chemistry and the
patient presented no symptoms or conditions associated with
hypercalcemia. Diagnosis was by preoperative imaging studies including
99mTc-sestabimi and surgical intervention stabilized calcium levels.
Parathyroid adenoma occurs in pre-school age children and its diagnosis
may be delayed because of the absence of symptoms.
31
UI - 11816519
AU - Ybarra J; Moises J; Torregrosa JV; Madhun ZT; Schumacher OP
TI -
[Effects of octreotide on serum and urine electrolytes in a patient with
parathyroid carcinoma: clinical case]
SO - Nefrologia 2001 Jul-Aug;21(4):406-10
AD - Unidad de Trasplante Renal Hospital Clinic 08036 Barcelona.
Parathyroid carcinoma (PC) is a rare endocrine tumor whose management is
difficult whenever surgery does not achieve complete en bloc resection
or recurrence is detected. Medical options (mainly bisphosphonates) are
scanty and often associated with toxic side-effects. We present a case
report of a patient with recurrent PC after two surgical interventions
who was treated with octreotide (SMS-201) taken into account the
positive somatostatin staining of the specimen obtained during the last
surgery. Short term effects (-2 weeks-) included a decrease in urinary
calcium excretion paired with a simultaneous increase in urinary
phosphorus excretion. Later on, continuous subcutaneous octreotide
administration kept urinary calcium excretion at low levels and this
effect was completely reversible/reinducible upon
discontinuation/reintroduction of the drug. Neither iPTH nor total serum
calcium were modified at short or long term basis. The lack of clear-cut
therapeutic effects make this findings a pure clinical observation.
Thus, octreotide cannot be recommended for the treatment of parathyroid
carcinoma.
32
UI - 11722090
AU - Ott MC; Malthaner RA; Reid R
TI -
Intraoperative radioguided thoracoscopic removal of ectopic parathyroid
adenoma.
SO - Ann Thorac Surg 2001 Nov;72(5):1758-60
AD - Department of Nuclear Medicine, London Health Sciences Centre,
University of Western Ontario, Canada.
Twenty-five percent of primary hyperparathyroidism is caused by ectopic
mediastinal parathyroid glands, with 2% of these not accessible to
standard cervical surgical approaches. Advancement in video-assisted
thoracoscopic surgical techniques has decreased the need for sternotomy
to successfully remove these ectopic glands. The thoracoscopic approach,
however, is limited by the surgeon's inability to always accurately
visualize ectopic glands. Intraoperative radionuclide-guided dissection,
using a thoracoscopic approach, provides a novel adjunct to the removal
of occult ectopic parathyroid glands. We report a case of an occult
ectopic parathyroid adenoma removed thoracoscopically using an
intraoperative handheld gamma probe.
33
UI - 11741745
AU - Tanaka C; Uchino S; Noguchi S; Nishioka T; Yamasaki H; Hashimoto K;
TI -
Yoshimoto K
Biallelic inactivation by somatic mutations of the MEN1 gene in sporadic
parathyroid tumors.
SO - Cancer Lett 2002 Jan 25;175(2):175-9
AD - Otsuka Department of Molecular Nutrition, School of Medicine, The
University of Tokushima, 3-18-15 Kuramoto-cho, 770-8503, Tokushima,
Japan.
We report three sporadic parathyroid tumors with biallelic inactivation
of the multiple endocrine neoplasia type 1 (MEN1) gene. Three
parathyroid tumors had two somatic mutations (K119del and 864del8,
363insT and 1767delT, and 508del33 and W341X, respectively). The
mutations in both alleles detected by long-range polymerase chain
reaction and subcloning in three tumors would likely result in a
nonfunctional menin protein in parathyroid glands. These results show
that the MEN1 gene is inactivated not only by a combination of somatic
mutations and loss of heterozygosity, but also by somatic double
mutations located on different alleles. The results directly confirmed
the participation of MEN1 in the tumorigenesis of sporadic parathyroid
tumors.
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