Endocrinol Metab.  2011 Jun;26(2):166-170. 10.3803/EnM.2011.26.2.166.

A Case of Primary Hyperparathyroidism Caused by Solitary Parathyroid Adenoma That was Not Detected by Both Ultrasonography and Sestamibi Scan

• Oh KY
• Choi B
• Lee Y
• Kim DH
• Yi HS
• Kim KJ
• Lee S
• Lim SK

• KMID: 1497725
• DOI: http://doi.org/10.3803/EnM.2011.26.2.166

Abstract

Thanks to advances in assay techniques and routine measurements in serum chemical analysis, primary hyperparathyroidism has become far more frequently detected, and the number of asymptomatic patients has substantially increased. In the majority of patients (85%), a solitary adenoma is the underlying cause of primary hyperparathyroidism. Surgical excision is the treatment of choice for most cases of primary hyperparathyroidism; this procedure has a relatively high success rate. In the past decade, improvements in preoperative imaging have played a major role in a targeted operative approach, which allows for minimally invasive surgery to be performed. The success of parathyroid surgery depends on the accurate preoperative localization of parathyroid adenoma. In this study, we report the case of a 54 year-old woman with primary hyperparathyroidism who presented with left buttock and leg pain. For localization of the parathyroid lesion, an ultrasonography and a 99mTc-sestamibi scan were initially performed, but these attempts failed to localize the lesion. We then carried out contrast-enhanced CT; thereafter, a single parathyroid adenoma was detected. Therefore, in patients with negative results on both ultrasonography and 99mTc-sestamibi scan, contrast-enhanced CT may prove helpful for preoperative parathyroid localization.

Keyword

Primary hyperparathyroidism; Parathyroid adenoma; Computerized tomography

MeSH Terms

Adenoma
Buttocks
Female
Humans
Hyperparathyroidism, Primary
Leg
Parathyroid Neoplasms
Technetium Tc 99m Sestamibi
Technetium Tc 99m Sestamibi

Figure

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  Fig. 1 99mTc-sestamibi scan shows no focal parathyroid uptake on 2-hour delayed image.

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  Fig. 2 Sequence chromatogram of parts of exon 7 of the CaSR gene from the proband. The arrow in the chromatogram indicates the presense of heterozygous missense nucleotide substitution due to T → C substitution at nucleotide 2968 causing R990G in the PCR with reverse primer.

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  Fig. 3 Contrast-enhanced CT of lower neck shows a contrast enhancing lesion posterior to the right lobe of thyroid gland (arrows).

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  Fig. 4 Microscopic findings of parathyroid gland show homogenous proliferative lesions without vascular invasion. The chief cells are predominant and arranged in acinar pattern. Nuclei are small round and have finely dense chromatin with faintly eosinophilic cytoplasm, consistent with parathyroid adenoma (A, H&E stain; × 40; B, × 400).

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