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Parathyroid Adenoma

Case Detail

Anatomy: Neck-Face
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Benign
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: CT NM
Activities:
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History

17 year old female with hypercalcemia.


Case Images


Diagnosis

Parathyroid Adenoma

Findings

NM – Conventional and SPECT/CT 99m-technitium sestamibi imaging demonstrates 1) normal distribution of radiopharmaceutical in the thyroid gland on early images, 2)normal thyroid washout but persistent activity in the lower left neck on delayed images, and 3)corresponding enlarged parathyroid gland on CT and SPECT/CT.

Discussion

Primary hyperparathyroidism in children is rare. When it is detected, it is generally due to a single parathyroid adenoma. Excess parathyroid hormone results in hypercalcemia which may cause symptoms such as muscular weakness, fatigue, headaches, abdominal pain, anorexia, nausea, vomitting, weight loss, and fever. Genetically associated syndromes, such as Multiple Endocrine Neoplasia, generally result in multigland hyperplasia rather than solitary adenomas.

Most people have two superior and two inferior parathyroid glands located bilateral and posterior to the thyroid gland, however ectopic parathyroid glands can arise along the embryologic origins of the third and fourth branchial pouch. Since the treatment for primary hyperparathyroidism is surgical excision of the abnormal parathyroid tissue, radiographic evaluation is necessary for localization. This may include any of the following: technetium-99m sestamibi scintigraphy, SPECT with CT localization, or neck sonography.

Scintigraphically, technetium 99m –sestamibi is taken up by hyperfunctioningl parathyroid and thyroid tissue on early images (10-15 minutes post injection). In dual-phase single-isotope imaging, delayed phase imaging (1.5-3 hours) demonstrates radiotracer wash out from normal thyroid gland while the tracer remains in the hyperfunctioning parathyroid gland allowing localization of the parathyroid adenoma. False positive studies occur with solitary thyroid adenomas and goiters. SPECT and CT fused imaging give additional anatomic information and further aids in localization of the hyperfunctioning parathyroid adenoma.

Reference

Eslamy, HK and Ziessman, HA. Parathyroid Scintigraphy in Patients with Primary Hyperparathyroidism: 99mTc Sestamibi SPECT and SPECT/CT. Radiographics September-October 2008 28:1461-1476.

Kollars J, Zarroug AE, van Heerden J, Lteif A, et al. Primary Hyperparathyroidism in Pediatric Patients. Pediatrics, Apr 2005; 115: 974 – 980.

Contributor

Jennifer Rollenhagen MD



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