The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Primary Hyperparathyroidism with Ectopic Parathyroid Adenoma Detected by Both $^{99m}Tc$-MIBI SPECT and Contrast-Enhanced Neck CT

$^{99m}Tc$-MIBI SPECT과 경부 CT로 진단된 이소성 부갑상선 선종 1예

  • Lim, Hye Jin (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Shin, Dong Geum (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Kim, Jun Bong (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Kim, Jin Taek (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Kim, Hyo Jeong (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Park, Man Sil (Department of Thoracic Surgery, Eulji University School of Medicine) ;
  • Lee, Ho Jeong (Department of Pathology, Eulji University School of Medicine)
  • 임혜진 (을지대학교 내과학교실) ;
  • 신동금 (을지대학교 내과학교실) ;
  • 김준봉 (을지대학교 내과학교실) ;
  • 김진택 (을지대학교 내과학교실) ;
  • 김효정 (을지대학교 내과학교실) ;
  • 박만실 (을지대학교 흉부외과학교실) ;
  • 이호정 (을지대학교 병리학교실)
  • Published : 2012.11.01
⟨ Previous Next ⟩

Abstract

An ectopic parathyroid gland is a major cause of persistent and recurrent hyperparathyroidism. Surgical success depends on accurate preoperative localization of the parathyroid adenoma. We herein report the case of a 52-year-old male patient who suffered from primary hyperparathyroidism for several years. He initially presented with urinary frequency, hypercalcemia, and a ureter stone. Ultrasonography and a $^{99m}Tc$-sestamibi scan were performed, but failed to localize the parathyroid lesion. Four years later, the patient revisited our hospital, complaining of general weakness, headache, dyspepsia, and recurrent urinary symptoms secondary to persistent primary hyperparathyroidism. In addition, renal function was decreased and severe osteoporosis was found. We performed a $^{99m}Tc$-sestamibi scan with single photon emission computed tomography ($^{99m}Tc$-MIBI SPECT) and contrastenhanced neck CT, and detected an ectopic parathyroid adenoma in the upper anterior mediastinum. In conclusion, the combination of both $^{99m}Tc$-MIBI SPECT and neck CT could permit better preoperative parathyroid localization, especially for mediastinal adenomas.

이소성 부갑상선은 지속성 또는 재발성 부갑상선항진증의 주요 원인이므로 부갑상선수술의 성공은 정확한 수술전 위치파악에 따라 달려 있다. 본 증례는 처음 원발성 부갑상선 기능항진증 진단을 받았으나 부갑상선 국소화 검사에 일반적으로 이용되는 경부 초음파 검사와 $^{99m}Tc$-sestamibi scan으로 병변 국소화가 되지 않고 추적 소실되었다가 증상이 악화되어 내원한 52세 남자 환자에 관한 보고이다. 저자들은 초기에 부갑상선 국소화에 실패하였으나 $^{99m}Tc$-MIBI SPECT과 경부 CT를 병합하여 시행한 후 지속적으로 부갑상선 기능항진증을 유발하는 이소성 부갑상선 종양을 종격동내에서 발견하였고 성공적으로 수술하였기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Shah S, Win Z, Al-Nahhas A. Multimodality imaging of the parathyroid glands in primary hyperparathyroidism. Minerva Endocrinol 2008;33:193-202.
  2. Wells SA Jr, Debenedetti MK, Doherty GM. Recurrent or persistent hyperparathyroidism. J Bone Miner Res 2002; 17(Suppl 2):N158-N162.
  3. Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med 1992;33:1801-1807.
  4. Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m) technetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 2002; 57:241-249. https://doi.org/10.1046/j.1365-2265.2002.01583.x
  5. Lumachi F, Tregnaghi A, Zucchetta P, et al. Technetium-99m sestamibi scintigraphy and helical CT together in patients with primary hyperparathyroidism: a prospective clinical study. Br J Radiol 2004;77:100-103. https://doi.org/10.1259/bjr/44399050
  6. Akram K, Parker JA, Donohoe K, Kolodny G. Role of single photon emission computed tomography/computed tomography in localization of ectopic parathyroid adenoma: a pictorial case series and review of the current literature. Clin Nucl Med 2009;34:500-502. https://doi.org/10.1097/RLU.0b013e3181abb619
  7. Kim SW, Kim SY, Park SH, et al. Ectopic parathyroid adenoma confirmed by re-exploration. Korean J Med 1985;28:414-421.
  8. Kang MS, Lee HY, Seo PJ, et al. A case of ectopic parathyroid carcinoma presenting with renal failure and anemia. Korean J Med 2006;71:435-441.
  9. Oh KY, Choi B, Lee Y, et al. A case of primary hyperparathyroidism caused by solitary parathyroid adenoma that was not detected by both ultrasonography and sestamibi scan. Endocrinol Metab 2011;26:166-170. https://doi.org/10.3803/EnM.2011.26.2.166
  10. Palestro CJ, Tomas MB, Tronco GG. Radionuclide imaging of the parathyroid glands. Semin Nucl Med 2005;35:266-276. https://doi.org/10.1053/j.semnuclmed.2005.06.001