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1.
BMJ Case Rep ; 14(2)2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33579799

RESUMO

Ectopic or supernumerary parathyroid tissue has been generally described in the literature in cases found during workup for parathyroid adenoma. We present two unique cases of intratracheal parathyroid gland, a rare occurrence that has not yet been described in the literature. In both cases, the masses were found incidentally and showed no clinical or laboratory evidence of hyperparathyroidism. In both cases, surveillance was chosen as the method of treatment. We present this case series to increase awareness of this potential diagnosis.


Assuntos
Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/fisiopatologia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/fisiopatologia , Neoplasias das Paratireoides/cirurgia , Traqueia/diagnóstico por imagem , Traqueia/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Resultado do Tratamento
3.
J Surg Oncol ; 123(4): 866-871, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33333584

RESUMO

BACKGROUND: Intraoperative near-infrared imaging (NIFI) of parathyroid glands (PG) by first-generation technology had limited image quality and depth penetration. Second-generation NIFI has recently been introduced. Our aim was to compare (1) capability to detect PG and (2) image quality between older and newer technologies. METHODS: Accurately detecting PG, as well as, quality of autofluorescence (AF) was compared between an older charge-coupled device (CCD) camera and a newer complementary metal-oxide semiconductor (CMOS). χ2 , t test, and analysis of variance were used for analysis. RESULTS: There were 300 patients who underwent parathyroidectomy (PTX) and/or thyroidectomy (THY) with NIFI, 200 with CCD, and 100 with CMOS. Although both NIFI technologies detected >94% of PG, CMOS was superior to CCD. Comparing AF quality, mean pixel intensity of PG compared with the background was higher with CMOS compared with CCD. When comparing PG detected by NIFI before visual identification by a surgeon, both CCD and CMOS had similar results (25% vs. 22%; p = .3). CONCLUSION: Both NIFI cameras were excellent at detecting PG. Second-generation NIFI (CMOS) displayed higher detection rates and AF intensity. Although surgeons identified majority of PG before NIFI detection, 25% of PG were identified with NIFI first, suggesting future advancements of this technology may expand its applications during parathyroid/thyroid operations.


Assuntos
Imagem Óptica/métodos , Doenças das Paratireoides/patologia , Glândulas Paratireoides/patologia , Semicondutores , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Feminino , Humanos , Masculino , Metais/química , Pessoa de Meia-Idade , Doenças das Paratireoides/diagnóstico por imagem , Doenças das Paratireoides/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Prognóstico , Estudos Prospectivos
4.
Ter Arkh ; 92(10): 78-82, 2020 Nov 24.
Artigo em Russo | MEDLINE | ID: mdl-33346483

RESUMO

Clinical observation of a young woman with chronic kidney disease IV stage and hyperparathyroidism is presented. Ultrasound and99mTc-sestamibi scintigraphy of the anterior surface of the neck visualized a tumor of the left upper parathyroid gland. In a histological examination of distant education was diagnosed a solid parathyroid adenoma. The difficulty of differential diagnosis between primary and secondary/tertiary hyperparathyroidism in chronic kidney disease is discussed.


Assuntos
Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Insuficiência Renal Crônica , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico por imagem , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/diagnóstico por imagem , Cintilografia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico
5.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370954

RESUMO

Type 1 multiple endocrine neoplasia (MEN-1) syndrome is an autosomal dominant disease, associated with germline mutations in the MEN-1 tumour suppressor gene (encoding the menin protein). Recent studies, through a better characterisation of the functions of the menin protein, have started to demonstrate how changes in this protein may be related to breast cancer. We present the case of a patient whose diagnosis of MEN-1 syndrome was made during treatment for a breast tumour-this diagnosis was obtained after finding multiple neoplastic lesions that fitted the MEN-1 syndrome spectrum, during the initial staging and subsequent follow-up of a breast tumour. In line with the growing evidence that links MEN-1 syndrome to breast cancer tumorigenesis, this case report highlights the following question: should we start screening this subset of patients earlier for breast cancer?


Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Proteínas Proto-Oncogênicas/genética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mama/diagnóstico por imagem , Mama/patologia , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Tumor Carcinoide/sangue , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/genética , Tumor Carcinoide/terapia , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/terapia , Feminino , Aconselhamento Genético , Mutação em Linhagem Germinativa , Humanos , Achados Incidentais , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/terapia , Imagem por Ressonância Magnética , Mamografia , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 1/complicações , Neoplasia Endócrina Múltipla Tipo 1/genética , Neoplasia Endócrina Múltipla Tipo 1/terapia , Mutação , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Glândulas Paratireoides/diagnóstico por imagem , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/genética , Neoplasias das Paratireoides/terapia , Paratireoidectomia , Pneumonectomia , Radioterapia Adjuvante , Tomografia Computadorizada por Raios X , Ultrassonografia Mamária
6.
Radiol Clin North Am ; 58(6): 1071-1083, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040849

RESUMO

Primary hyperparathyroidism (PHPT) is a common endocrine abnormality, caused in most cases by a single parathyroid adenoma. Surgery remains the first-line curative therapy in PHPT. Imaging plays a vital role in presurgical localization of parathyroid adenomas. Ultrasound provides a safe and quick imaging modality free of ionizing radiation, but is operator dependent. Sestamibi scan offers comparable sensitivity to ultrasound, improved with concurrent tomographic imaging. 4DCT remains a problem-solving technique in challenging cases and after failed neck exploration. We present an overview of various parathyroid imaging modalities, including protocols and findings, in addition to relevant pearls and pitfalls.


Assuntos
Hiperparatireoidismo Primário/diagnóstico por imagem , Imageamento Tridimensional , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X/métodos , Diagnóstico por Imagem/métodos , Feminino , Humanos , Hiperparatireoidismo Primário/etiologia , Masculino , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Prognóstico , Compostos Radiofarmacêuticos , Resultado do Tratamento , Ultrassonografia Doppler/métodos
8.
Medicine (Baltimore) ; 99(28): e21176, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664158

RESUMO

Tc-99m sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has been used to help surgeons explore the location of parathyroid diseases, but quantitative parameters have not been systemically investigated for this purpose. We aimed to establish objective criteria for adenoma and hyperplasia using the standardized uptake value (SUV) in patients with hyperparathyroidism.Thirty-nine hyperparathyroid patients (male/female: 17/22, age: 58.33 ±â€Š11.69 years) with at least 1 uptake-positive lesion of any degree by visual assessment in preoperative Tc-99m sestamibi quantitative SPECT/CT were included from Oct 2015 to Oct 2017. Pathologically, 44 lesions (32 adenomas and 12 hyperplasia) were identified. All patients experienced normalized levels of intact parathyroid hormone immediately after surgery. Quantitative SPECT/CT was performed at 10 minute and 2 hour post injection of Tc-99m sestabmibi (dose = 740 MBq), and maximum SUV (SUVmax) was measured for the parathyroid lesions. Experienced pathologists evaluated the percentage cellular proportions of chief cells, oxyphil cells, and clear cells.SUVmax (g/mL) of adenomas, hyperplasia, and reference thyroid tissue were 12.92 ±â€Š6.68, 7.90 ±â€Š5.49, and 7.01 ±â€Š2.62 at 10min (early phase), decreasing to 7.46 ±â€Š5.66, 4.65 ±â€Š3.14, and 2.21 ±â€Š1.07 at 2 hour (delayed phase), respectively. The adenomas showed significantly higher SUVmax than both the hyperplasia (P = .0131) and reference thyroid tissue (P < .0001) along the early and delayed phases, but the SUVmax of the hyperplasia did not differ from that of the reference thyroid tissue (P = .4196). The adenomas and hyperplasia were discriminated from the reference thyroid tissue using a cutoff SUVmax of 3.26 at the delayed phase. The adenomas had lower %proportions of oxyphil cells than the hyperplasia (P = .0054), but its SUVmax at the delayed phase was positively correlated with the %proportions of mitochondria-abundant oxyphil cells (rho = 0.418, P = .0173). The hyperplasia showed no correlation between SUVmax and cellular proportions.SUVmax at the delayed phase in the Tc-99m sestamibi quantitative SPECT/CT was useful for the identification and differentiation of parathyroid lesions causing hyperparathyroidism.


Assuntos
Adenoma/diagnóstico por imagem , Hiperparatireoidismo/diagnóstico por imagem , Glândulas Paratireoides/patologia , Neoplasias das Paratireoides/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Adenoma/etiologia , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Hiperparatireoidismo/complicações , Hiperparatireoidismo/patologia , Hiperplasia/diagnóstico por imagem , Hiperplasia/etiologia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/etiologia , Estudos Retrospectivos
10.
Am J Surg ; 220(3): 533-535, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32362380

RESUMO

BACKGROUND: Most patients with primary hyperparathyroidism undergo localization prior to operation with variable success. Therefore, in this study we investigated the safety of parathyroidectomy without imaging. METHODS: A prospective database of 2057 surgical patients with primary hyperparathyroidism from 2001 to 2019 was reviewed. Patients were categorized by use of preoperative imaging (ultrasound, sestamibi, CT scan), pathology, and cure. RESULTS: 1879 (91%) patients underwent preoperative imaging. CT scan was the most sensitive study (92%), though specificity was only 64%. Patients with imaging were older, had higher pre- and postoperative calcium, more likely to undergo unilateral exploration and have an adenoma (p < 0.001-0.038). No differences were seen in nerve injury (<1%), postoperative hypocalcemia (<1%), or cure rate. CONCLUSIONS: While localization may lead to minimally-invasive operations, we observed no differences in postoperative complications or cure rates in the hands of an experienced surgeon. Therefore, preoperative parathyroid localization does not improve outcomes for hyperparathyroidism and can be ordered sparingly.


Assuntos
Hiperparatireoidismo Primário/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paratireoidectomia , Cuidados Pré-Operatórios , Estudos Prospectivos , Sensibilidade e Especificidade
11.
Medicine (Baltimore) ; 99(19): e19989, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384452

RESUMO

This study aimed to establish an optimal protocol for Tc-sestamibi parathyroid imaging for lesion localization in patients with hyperparathyroidism (HPT).We retrospectively enrolled 35 consecutive patients who underwent dual-phase (at 10 minutes and 120 minutes) Tc-sestamibi parathyroid scintigraphy with single-photon emission computed tomography (SPECT)/computed tomography (CT). Twenty seven patients had primary HPT, and 8 had secondary or tertiary HPT. Three nuclear medicine physicians independently analyzed the parathyroid images for lesion localization at 9 predefined parathyroid locations using the following 4 different image sets blinded to the clinical information:All SPECT or SPECT/CT image sets were analyzed with dual-phase planar images. The image results were compared with the histopathological results after surgery.Dual-phase SPECT/CT showed the highest positive rate of 85.7% in the patient-based analysis and 13.7% in the location-based analysis. Of 35 patients, surgical pathological results were available in 21 (16 adenomas in 16 primary HPTs and 16 hyperplasias in 5 secondary or tertiary HPTs). Dual-phase SPECT/CT showed the sensitivity values of 100% and 84.4% in the patient-based and location-based analysis, respectively, which were the highest sensitivity values among all image sets. In the primary HPT subgroup, dual-phase SPECT/CT showed the highest sensitivity value of 93.8% in the location-based analyses, whereas dual-phase SPECT, early SPECT/CT, and delayed SPECT/CT showed the sensitivity values of 62.5%, 81.3%, and 81.3%, respectively. In the secondary or tertiary HPT subgroup, dual-phase SPECT/CT also showed the highest sensitivity value of 75.0%, whereas early SPECT/CT, delayed SPECT/CT, and dual-phase SPECT showed the sensitivity values of 43.8%, 56.3%, and 68.8%, respectively.Compared with dual-phase SPECT or single-phase SPECT/CT, the dual-phase SPECT/CT imaging protocol for Tc-sestamibi scintigraphy showed the highest positive rate and sensitivity, and was optimal for parathyroid lesion localization.


Assuntos
Hiperparatireoidismo , Hiperplasia , Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides , Cintilografia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tecnécio Tc 99m Sestamibi/farmacologia , Feminino , Humanos , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/etiologia , Hiperplasia/diagnóstico , Hiperplasia/patologia , Hiperplasia/cirurgia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Cintilografia/métodos , Cintilografia/normas , Compostos Radiofarmacêuticos/farmacologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Ann R Coll Surg Engl ; 102(8): e192-e195, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32436720

RESUMO

We describe the case of an 89-year old Caucasian woman admitted with confusion and severe clinical manifestations of acute hypercalcaemia. There was no history suggestive of any malignancy and initial management included correction of the hypercalcaemia with intravenous fluid therapy. Sestamibi parathyroid scintigraphy and neck ultrasonography demonstrated a 4cm left-sided thyroid lesion and a nearly 2cm right-sided thyroid lesion. The patient underwent a total thyroidectomy and parathyroidectomy. Histology confirmed a concomitant parathyroid adenoma, parathyroid carcinoma and follicular thyroid carcinoma. To our knowledge, this is the first reported case in the literature.


Assuntos
Adenocarcinoma Folicular , Neoplasias das Paratireoides , Neoplasias da Glândula Tireoide , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipercalcemia/etiologia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Cintilografia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Tireoidectomia
14.
Clin Nucl Med ; 45(8): 636-637, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32453078

RESUMO

We present the first intraoperative detection of a hyperplastic parathyroid gland with a positron emitter F-fluorocholine and handheld probe, with the estimation of the absorbed dose to the surgeon and surgical staff. Intraoperative positron emitter detection enabled the resection of a small parathyroid gland, resulting in normal postoperative values of PTH and serum calcium in a 69-year-old woman. Calculated whole-body dose to the surgical staff and surgeons' fingers is well below the annual limits for exposed workers and the general public. Intraoperative F-FCH detection with handheld probe is a safe and feasible method for localizing small parathyroid glands.


Assuntos
Hiperparatireoidismo Primário/diagnóstico por imagem , Monitorização Intraoperatória/métodos , Glândulas Paratireoides/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Idoso , Colina/análogos & derivados , Feminino , Humanos , Hiperparatireoidismo Primário/patologia , Hiperparatireoidismo Primário/cirurgia , Monitorização Intraoperatória/instrumentação , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Tomografia por Emissão de Pósitrons/instrumentação , Compostos Radiofarmacêuticos
15.
PLoS One ; 15(5): e0233685, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32470047

RESUMO

Ultrasonographic examination of the normal thyroid and parathyroid glands has been described for humans and many animal species. However, similar reports for goats are still missing. The aim of the study was to present ultrasound features of the normal thyroid and internal parathyroid glands in goats with the determination of their dimensions and volume, followed by a comparison of the results to the gross examination. Seventy-two goats were used in the study. The echostructure and echogenicity of the thyroid and parathyroid glands were assessed. The length, width and height of the thyroid and the length and width of the parathyroid glands were measured. The thyroid volume was calculated using the ellipsoid formula, basing on the ultrasonographic dimensions. Size and volume of the dissected thyroid glands were established grossly, followed by a histological examination. In order to accurately describe the anatomy of the thyroid, new anatomical terminology characterizing this gland was proposed. The mean dimensions of the thyroid lobes were 30.2 x 10.5 x 6.3 mm. There were no statistically significant differences between the right and left lobe. Parathyroid glands measured an average of 3.6 x 2.4 mm. The percentage Root Mean Square Error between the results of ultrasonographic and gross examination was 16.73%, 20.65% and 17.01% for thyroid length, width and height, respectively, and 46.30% for volume. In order to obtain more precise calculation of the thyroid volume, a modified correction factor for the ellipsoid formula was introduced. For the first time, the normal ultrasonographic characteristics and dimensions of the caprine thyroid and internal parathyroid glands were presented. The results may serve as a radiological reference and be the basis for further research.


Assuntos
Cabras , Glândulas Paratireoides/diagnóstico por imagem , Glândula Tireoide/diagnóstico por imagem , Animais , Feminino , Ultrassonografia
16.
J Surg Res ; 252: 216-221, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32289578

RESUMO

BACKGROUND: The addition of SPECT-CT to Tc-99 sestamibi has become a valuable tool for parathyroid localization in primary hyperparathyroidism (PHP). However, the enhanced sensitivity of this test can lead to unexpected and significant findings. We sought to identify the frequency and types of nonparathyroid detections by SPECT-CT. MATERIALS AND METHODS: With institutional approval, we reviewed all SPECT-CT studies performed for PHP between October 2012 and August 2018 for incidental nonparathyroid abnormalities. The electronic medical record was referenced to determine the type of lesion confirmed by additional evaluation. RESULTS: Among 2413 studies, 652 patients (27%) had 677 (28%) nonparathyroid findings. The most common were thyroid nodules (331/677, 49%), including 47 (6.9%) malignancies to date: 40 papillary thyroid cancers (11 microcarcinomas), five follicular thyroid cancers, one medullary carcinoma, and one noninvasive follicular thyroid neoplasm with papillary-like features. One hundred and seventy-seven patients had pulmonary nodules (26%), of whom nine were diagnosed with primary lung lesions (6 non-small-cell cancers, one small-cell cancer, one carcinoid, and one pulmonary sequestration). SPECT-CT revealed 14 patients (2.1%) with breast abnormalities, including three cancers. Nine patients (1.3%) demonstrated metastatic diseases within the lungs (4), bones (3), and mediastinum (2). One patient was diagnosed with follicular lymphoma. Two intracranial tumors were also identified, as well as dysplastic Barrett's esophagitis (1), hiatal hernia (20, 3%), and aortic aneurysm (13, 1.8%). In all, 72/677 (10.6%) PHP patients exhibited premalignant or malignant nonparathyroid SPECT-CT findings. CONCLUSIONS: In patients undergoing localization for PHP with Tc-99 sestamibi SPECT-CT, nonparathyroid findings are frequent (27%) and can lead to newly diagnosed malignant or premalignant lesions in at least 3% of patients to date.


Assuntos
Hiperparatireoidismo Primário/diagnóstico por imagem , Achados Incidentais , Neoplasias Pulmonares/epidemiologia , Neoplasias da Glândula Tireoide/epidemiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Glândulas Paratireoides/diagnóstico por imagem , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Tecnécio Tc 99m Sestamibi , Neoplasias da Glândula Tireoide/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos
17.
Ann R Coll Surg Engl ; 102(6): e111-e114, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32233855

RESUMO

INTRODUCTION: Bilateral giant parathyroid adenoma in the absence of multiple endocrine neoplasia (MEN) type 1 is extremely rare and literature on this subject is limited. CASE HISTORY: A 79-year-old man presented with acute kidney injury secondary to hypercalcaemia. Blood test results indicated primary hyperparathyroidism. Ultrasonography revealed bilateral parathyroid adenomas measuring 19.4mm x 19.5mm x 18.8mm (left) and 15.2mm x 18.3mm x 19.6mm (left) whereas on computed tomography, the measurements were 31mm x 20mm (left) and 30mm x 14mm (right). Intraoperatively, giant adenomas measuring 50mm x 25mm x 12mm (left, weighing 8.101g) and 48mm x 22mm x 10mm (right, weighing 7.339g) were identified and excised. Parathyroid hormone level dropped from 44.6pmol/l preoperatively to 8.9pmol/l postoperatively (normal range 1.3-7.6pmol/l). The patient was discharged with no complications. CONCLUSIONS: We report a rare phenomenon where bilateral giant parathyroid adenoma occurred in the absence of MEN type 1. It highlights the importance of cross-sectional imaging in delineating the anatomy of adenomas as their size can be grossly underestimated by ultrasonography alone.


Assuntos
Adenoma/diagnóstico , Hiperparatireoidismo Primário/diagnóstico , Glândulas Paratireoides/patologia , Neoplasias das Paratireoides/diagnóstico , Paratireoidectomia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/etiologia , Adenoma/complicações , Adenoma/patologia , Adenoma/cirurgia , Idoso , Cálcio/sangue , Diagnóstico Diferencial , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/cirurgia , Masculino , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/patologia , Neoplasias das Paratireoides/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral , Ultrassonografia
18.
Clin Nucl Med ; 45(6): 480-482, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32209876

RESUMO

A 10-year-old boy presented with back pain. Tc-methylene diphosphonate bone scan demonstrated the sign of metabolic bone disease, suspected due to hyperparathyroidism. Tc-sestamibi parathyroid SPECT/CT demonstrated focal lesion in the lower pole of the right lobe. The pathological examination demonstrated parathyroid carcinoma, which is very rare in pediatric population.


Assuntos
Glândulas Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi , Criança , Humanos , Hiperparatireoidismo/complicações , Masculino , Neoplasias das Paratireoides/complicações
19.
J Bone Miner Metab ; 38(4): 570-580, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32100109

RESUMO

INTRODUCTION: Parathyroid venous sampling (PVS) has been reported to be a useful adjunctive test in localizing lesions in elusive cases of primary hyperparathyroidism (PHPT). Conventional cutoff (twofold) is now widely being used, but optimal cutoff threshold for PVS gradient based on discriminatory performance remains unclear. MATERIALS AND METHODS: Among a total of 197 consecutive patients (mean age 58.2 years, female 74.6%) with PHPT who underwent parathyroidectomy at a tertiary center between 2012 and 2018, we retrospectively analyzed 59 subjects who underwent PVS for persistent or recurrent disease after previous parathyroidectomy, or for equivocal or negative results from conventional imaging modalities including ultrasonography (US) and Tc99m-Sestamibi SPECT-CT (MIBI). True parathyroid lesions were confirmed by combination of surgical, pathological findings, and intraoperative parathyroid hormone (PTH) changes. Optimal PVS cutoff were determined by receiver-operating characteristics (ROC) analysis with Youden and Liu method. RESULTS: Compared to subjects who did not require PVS, PVS group tends to have lower PTH (119.8 pg/mL vs 133.7 pg/mL, p = 0.075). A total of 79 culprit parathyroid lesions (left 40; right 39) from 59 patients (left 24; right 26; bilateral 9) were confirmed by surgery. The optimal cutoff for PVS gradient was estimated as 1.5-fold gradient (1.5 ×) with sensitivity of 61.8% and specificity of 84%. When 1.5 × cutoff was applied, PVS improved the discrimination for true parathyroid lesions substantially based on area under ROC (0.892 to 0.942, p < 0.001) when added to US and MIBI. CONCLUSION: Our findings suggest that PVS with cutoff threshold 1.5 × can provide useful complementary information for pre-operative localization in selected cases.


Assuntos
Hiperparatireoidismo Primário/sangue , Glândulas Paratireoides/cirurgia , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Hormônio Paratireóideo/sangue , Curva ROC , Estudos Retrospectivos , Ultrassonografia
20.
BMC Surg ; 20(1): 4, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31907042

RESUMO

BACKGROUND: To evaluate the efficacy of a sensitive, real-time tool for identification and protection for parathyroid glands during thyroidectomy. METHODS: Near-infrared (NIR) auto-fluorescence was measured intraoperatively from 20 patients undergoing thyroidectomy. Spectra were measured from suspicious parathyroid glands and surrounding neck tissues during the operation with a NIR fluorescence system. Fast frozen sections were performed on the suspicious parathyroid glands. Accuracy was evaluated by comparison with histology and NIR identification. Data were attracted for Fisher's linear discriminant analysis. RESULTS: The auto-fluorescence intensity of parathyroid was significantly higher than that of thyroid, fat and lymph node. The peak intensity of auto-fluorescence from parathyroid was 5.55 times of that from thyroid at the corresponding wave number. Of the 20 patients, the parathyroid was accurately detected and identified in 19 patients by NIR system, compared with their histologic results. One suspicious parathyroid did not exhibit typical spectra, and was proved to be fat tissue by histology. The NIR auto-fluorescence method had a 100% sensitivity of parathyroid glands identification and a high accuracy of 95%. The positive predictive value was 95%. The parathyroid gland have specific auto-fluorescence spectrum and can be separated from the other three samples through the Fisher's linear discriminant analysis. CONCLUSIONS: NIR auto-fluorescence spectroscopy can accurately identify normal parathyroid gland during thyroidectomy. The Fisher's linear discriminant analysis demonstrated the specificity of the NIR auto-fluorescence of parathyroid tissue and its efficacy in parathyroid discrimination.


Assuntos
Glândulas Paratireoides/diagnóstico por imagem , Espectrometria de Fluorescência/métodos , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Cirurgia Assistida por Computador/métodos , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Idoso , Análise Discriminante , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Curva ROC , Neoplasias da Glândula Tireoide/diagnóstico
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