ROLE OF IMAGING TESTS FOR PREOPERATIVE LOCATION OF PATHOLOGIC PARATHYROID TISSUE IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM.

OBJECTIVE: Primary hyperparathyroidism (PHPT) can be cured by parathyroidectomy, and the preoperative location of enlarged pathologic parathyroid glands is determined by imaging studies, especially cervical ultrasonography and scintigraphy scanning. The aim of this retrospective study was to evaluate the use of preoperative cervical ultrasonography and/or parathyroid scintigraphy in locating pathologic parathyroid tissue in a group of patients with PHPT followed in the same endocrine center. METHODS: We examined the records of 61 patients who had undergone parathyroidectomy for PHPT following (99m)Tc-sestamibi scintigraphy scan and/or cervical ultrasonography. Scintigraphic and ultrasonographic findings were compared to histopathologic results of the surgical specimens. RESULTS: Ultrasonography detected enlarged parathyroid glands in 87% (48/55) of patients with PHPT and (99m)Tc-sestamibi scintigraphy in 79% (37/47) of the cases. Ultrasonography was able to correctly predict the surgical findings in 75% (41/55) of patients and scintigraphy in 72% (34/47). Of 7 patients who had negative ultrasonography, scintigraphy correctly predicted the surgical results in 2 (29%). Of 10 patients who had negative scintigraphy, ultrasonography correctly predicted the surgical results in 4 (40%). When we analyzed only patients with solitary eutopic parathyroid adenomas, the predictive positive values of ultrasonography and scintigraphy were 90% and 86%, respectively. CONCLUSION: Cervical ultrasonography had a higher likelihood of a correct positive test and a greater predictive positive value for solitary adenoma compared to (99m)Tc-sestamibi and should be used as the first diagnostic tool for preoperative localization of affected parathyroid glands in PHPT. ABBREVIATIONS: Ca = calcium IEDE = Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione PHPT = primary hyperparathyroidism PTH = parathyroid hormone.

Hiperparatireoidismo primário familiar isolado: análise e descrição de uma família com seis casos índices: [carta ao editor] / Familial isolated primary hyperparathyroidism: description and analyses of six cases: [letter to the editor]

Objetivamos descrever e analisar uma família com seis casos de hiperparatireoidismo familiar isolado (HFI), uma rara doença hereditária de padrão autossômico dominante, caracterizada por hiperparatireoidismo primário sem associação com outras doenças ou tumores endocrinológicos. O diagnóstico foi realizado através da demonstração de hipercalcemia, aumento dos níveis de paratormônio e tumores de paratireóide à histopatologia, excluindo-se neoplasias endócrinas múltiplas do tipo 1 (NEM 1) e do tipo 2a (NEM 2a), além da síndrome hiperparatireoidismo/tumor de mandíbula (HPT/TM). Analisamos a descrição dos exames diagnósticos iniciais, a abordagem cirúrgica, os laudos histopatológicos pós-operatórios e suas evoluções. A primeira paciente operada neste instituto há 20 anos, recidivou onze anos após, e possuía uma irmã com diagnóstico prévio, o que motivou a investigação de outros familiares. A observação do caráter familial nesses pacientes contribuiu para a facilitação diagnóstica e encaminhamento terapêutico dos mesmos, assim como a orientação clínica e genética à família.

Our objective is to evaluate and describe one family with six cases of familial isolated primary hyperparathyroidism (HFI), a rare hereditable disorder with an autossomal dominant mode of inheritance. It is characterized by a primary hyperparathyroidism without association with other endocrine tumors or diseases. The HFI diagnosis relied on the demonstration of hypercalcemia, inappropriately high levels of parathyroid hormone, and parathyroid adenomas, plus exclusion of NEM 1/2a and HPT/TM syndrome in this family. We analyzed the description of the first diagnosis, surgical approach, postoperative histopathological results and their development process. The first patient, treated in our institute twenty years ago, has recidivated eleven years after the treatment. Her sister had had the same diagnosis, which motivated us to investigate theirs relatives. The analysis of the characteristics that run in these patients' family has contributed to facilitate their diagnosis and therapeutic treatment, including clinical and genetic orientation of this family.

Valor dos indicadores ultra-sonográficos no manuseio dos nódulos tiroidianos / The value of sonographic criteria on the management of thyroid nodules

Objetivos: Avaliar o desempenho da USG no diagnóstico de neoplasia maligna de tireóide. Métodos: Em 94 indivíduos encaminhados para avaliação de nódulo tireoidiano foram re­alizadas USG e PAAF e, nos 56 casos submetidos à ressecção cirúrgica dos nódulos, efetuado o presente estudo. Resultados: Lesão tireoidiana benigna ocorreu em 47 ca­sos. O diâmetro dos nódulos foi semelhante: 3,1 mais ou menos 0,8 cm e 3,3 mais ou menos 1,7 em, nos grupos maligno e benigno, respectivamente. Quanto à nodularidade, foi semelhante a prevalência de carci­noma: 11,1 % e 18,5% dos nódulos únicos e múltiplos, respec­tivamente. Microcalcificações e hipoecogenicidade foram mais comuns no grupo com carcinoma. Quando ambas as caracte­rísticas estavam presentes obtivemos sensibilidade de 33,3% (IC de 95%: 7,5% a 70,1%), especificidade de 100% (IC de 95%: 92% a 100%), VPP de 100%, VPN de 88,7% e acurácia de 89,3% (p igual 0,003). Em concordância com a literatura, o diâmetro e o número de nódulos não permitem conclusões sobre as características histopatológicas dos mesmos. Os achados de USG, sobretudo a presença de microcalcificações e hipoecoge­nicidade, em associação apresenta boa especificidade no diagnóstico das neoplasias malignas de tireóide. Conclusão: A USG na investigação da doença nodular tireoidiana exibe bom desempenho, merecendo destaque na pro­pedêutica desse grupo de pacientes.

[Familial isolated primary hyperparathyroidism--description and analyses of six cases]. / Hiperparatireoidismo primário familiar isolado--análise e descrição de uma família com seis casos índices.

Our objective is to evaluate and describe one family with six cases of familial isolated primary hyperparathyroidism (HFI), a rare hereditable disorder with an autossomal dominant mode of inheritance. It is characterized by a primary hyperparathyroidism without association with other endocrine tumors or diseases. The HFI diagnosis relied on the demonstration of hypercalcemia, inappropriately high levels of parathyroid hormone, and parathyroid adenomas, plus exclusion of NEM 1/2a and HPT/TM syndrome in this family. We analyzed the description of the first diagnosis, surgical approach, postoperative histopathological results and their development process. The first patient, treated in our institute twenty years ago, has recidivated eleven years after the treatment. Her sister had had the same diagnosis, which motivated us to investigate theirs relatives. The analysis of the characteristics that run in these patients' family has contributed to facilitate their diagnosis and therapeutic treatment, including clinical and genetic orientation of this family.