ABSTRACT
RESUMEN El hiperparatiroidismo terciario es una complicación presentada en pacientes con enfermedad renal crónica llevados a trasplante renal cuyo manejo quirúrgico requiere de la ubicación mediante imágenes diagnosticas para garantizar el éxito de esta intervención. Se presenta caso de mujer en hemodiálisis crónica que presentó hiperparatiroidismo terciario por hiperplasia paratiroidea confirmada con Tc-99m MIBI SPECT.
ABSTRACT Tertiary hyperparathyroidism is a complication presented in patients with chronic kidney disease subjected to renal transplantation whose surgical management requires location through diagnostic images to guarantee the success of this intervention. We present the case of a woman on chronic hemodialysis who presented tertiary hyperparathyroidism due to parathyroid hyperplasia confirmed by Tc-99m MIBI SPECT.
ABSTRACT
This paper aims to present one of the rarest types of malignancies, parathyroid carcinoma. Parathyroid carcinoma is an important cause of primary hyper par athyroidism. Diagnostic evaluation of patients presenting with signs and symptoms of hyperparathyroidism consists of serum calcium and parathyroid hormone determination, parathyroid imaging using ultrasound, computed tomography, magnetic resonance imaging, or Tc-99m sestamibi scintigraphy, and histopathologic evaluation of tissues after surgical intervention. Therapeutic management of an identified parathyroid tumor is by parathyroidectomy during neck exploration or radioisotope-guided with the use of a gamma probe. The histology of a resected tumor determines if the initial surgery completes the management, or, in cases of parathyroid carcinoma, if another completion surgical intervention is to be made. This paper will present a patient who has been initially diagnosed with primary hyperparathyroidism and was referred to our nuclear medicine department for parathyroid scintigraphy. The patient underwent MIRP and rapid intraoperative PTH determination. Histopathologic report on the tissues revealed parathyroid carcinoma. The patient underwent a second surgery for definitive treatment. This paper will discuss the clinical role of nuclear medicine in the diagnosis and surgical management of parathyroid carcinoma.
Subject(s)
Humans , Female , Aged , Calcium , Hyperparathyroidism, Primary , Magnetic Resonance Imaging , Nuclear Medicine , Parathyroid Glands , Parathyroid Hormone , Parathyroid Neoplasms , Parathyroidectomy , Radioisotopes , Radionuclide Imaging , Technetium Tc 99m Sestamibi , Tomography , Hypertension , Kidney CalculiABSTRACT
Tc-99m methoxyisobutylisonitrile (MIBI) and Tl-201/technetium subtraction scintigraphy have been used for localization of abnormal parathyroid gland. The uptake mechanism of tracers has been postulated to be increased cellular density and vascularity, or dependent on the presence of mitochondria-rich cells. However, the uptake of these tracers was not specific for abnormal parathyroid gland. The author report a case of thymic carcinoma that would have been mistaken for carcinoma of parathyroid because of Tc-99m MIBI and Tl-201 uptake.