[Value of radioguided surgery with dobutamine 99mTc-MIBI in persistent secondary hyperparathyroidism]. / Valor de la cirugía radioguiada con 99mTc-MIBI sensibilizada con dobutamina en el hiperparatiroidismo secundario persistente.

99mTc-MIBI is a radiopharmaceutical that has been successfully used for the detection of hyperfunctioning parathyroid glands and for radioguided surgery techniques. We report on the case of a 55 year old woman in hemodialysis, with secondary persistent hyperparathyroidism after total parathyroidectomy. The conventional double-phase 99mTc-MIBI parathyroid scintigraphy was negative. The study was repeated after sensibilization with intravenous low-dose dobutamine showing an area of increased focal uptake in the lower cervical region. With this finding, radioguided 99mTc-MIBI surgery was performed after dobutamine administration, using a hand held gamma probe. The technique was considered successful with the resection of parathyroid cervical tissue which was further confirmed as nodular hyperplasia. We conclude that this methodology has the potential of being a an useful tool for the intraoperative localization of remanent tissue in patients with secondary persistent/recurrent hyperparathyroidism.

Valor de la cirugía radioguiada con 99mTc-MIBI sensibilizada con dobutamina en el hiperparatiroidismo secundario persistente / Value of radioguided surgery with dobutamine 99mTc-MIBI in persistent secondary hyperparathyroidism

El 99mTc-MIBI es un radiofármaco que ha sido utilizado exitosamente en la exploración de glándulas paratiroides hiperfuncionantes y en técnicas de cirugía radioguiada. Presentamos el caso de una paciente de 55 años en hemodiálisis, portadora de hiperparatiroidismo secundario (HPS) persistente post paratiroidectomía total. Se realizó gammagrafía convencional de doble fase con 99mTc-MIBI que fue negativa. El estudio fue posteriormente repetido mediante sensibilización previa con dobutamina intravenosa a bajas dosis, evidenciando un foco de captación focal en base de cuello. Con este hallazgo, la paciente fue nuevamente sometida a cirugía, realizándose en esta oportunidad técnica radioguiada por sonda gamma con inyección de 99mTc-MIBI posterior a infusión de dobutamina. La técnica resultó exitosa con resección de tejido paratiroideo, el cual fue posteriormente confirmado como hiperplasia nodular. Se concluye que la estrategia propuesta tiene el potencial de facilitar la localización de tejido remanente en pacientes con HPS persistente/recurrente

99mTc-MIBI is a radiopharmaceutical that has been successfully used for the detection of hyperfunctioning parathyroid glands and for radioguided surgery techniques. We report on the case of a 55 year old woman in hemodialysis, with secondary persistent hyperparathyroidism after total parathyroidectomy. The conventional double-phase 99mTc-MIBI parathyroid scintigraphy was negative. The study was repeated after sensibilization with intravenous low-dose dobutamine showing an area of increased focal uptake in the lower cervical region. With this finding, radioguided 99mTc-MIBI surgery was performed after dobutamine administration, using a hand held gamma probe. The technique was considered successful with the resection of parathyroid cervical tissue which was further confirmed as nodular hyperplasia. We conclude that this methodology has the potential of being a an useful tool for the intraoperative localization of remanent tissue in patients with secondary persistent/recurrent hyperparathyroidism