APPROACH TO A PATIENT WITH CLINICALLY AND BIOCHEMICALLY ACTIVE PRIMARY HYPERPARATHYROIDISM DESPITE NEGATIVE SESTAMIBI 99MTC

Ahmeti, Irfan and Nazifi, Avdi and Ahmeti Jakupi, Sebajet and Mickoska, Aleksandra and Mladenoska Stojkoska, Ivana (2024) APPROACH TO A PATIENT WITH CLINICALLY AND BIOCHEMICALLY ACTIVE PRIMARY HYPERPARATHYROIDISM DESPITE NEGATIVE SESTAMIBI 99MTC. ACTA MEDICA BALKANICA International Journal of Medical Sciences, 9 (17-18). pp. 164-169. ISSN 2545 - 4870

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Abstract

Introduction: Primary hyperparathyroidism (PHPT) resulting from increased parathyroid hormone (PTH) secretion. In 80% of cases the cause is a solitary adenoma. It occurs more often in women. The gold standard in the diagnosis of PHPT is MIBI 99m Tc scintigraphy. Patient presentation. A 35-year-old women is referred to outpatient clinic due to high values of PTH, calcium and frequent recurring nephrolithiasis. From the laboratory analysis we show: PTH 317 pg/ml, Ionized calcium 1.71 (1.16 to 1.31 mmol/L); phosphates 0.73mmol/L; Vitamine D3 18.68 ng/ml. The patient is referred for neck ultrasound and bone densitometry (DEXA). A hypoechoic nodule with dimensions of 0.69x0.63x0.67 cm is visualized on ultrasound under the right lobe of the thyroid gland. In the DEXA scan, osteopenia is detected (T-score -2.2). Sestamibi scintigraphy was performed in two repetitions where no adenoma of the parathyroid gland was detected. The patient is referred for neck computed tomography (CT); a small nodule suspicious for parathyroid adenoma is visualized. Due to the clinical manifestation and the constant high values of hypercalcemia, the patient is referred for parathyroidectomy. After the operation, a few days later, the values of PTH (63.5 pg/ml) and ionized calcium (1.18 mmol/L) were normal. Conclusion. Sestamibi scintigraphy is rarely negative during clear clinical and biochemical signs. The sensitivity of Sestamibi is 80-100%, and in cases where it is negative, especially when the volume of the nodule in PHPT is small, additional analyzes such as neck CT, 18FCholine PET/CT enable the decision-making of the definitive treatment – parathyroidectomy in PHPT.

Item Type:	Article
Uncontrolled Keywords:	Hyperparathyroidism, 99MTC, endocrinology.
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medicine, Health and Life Sciences > School of Medicine
Depositing User:	Unnamed user with email zshi@unite.edu.mk
Date Deposited:	01 Oct 2024 12:07
Last Modified:	01 Oct 2024 12:07
URI:	http://eprints.unite.edu.mk/id/eprint/1751

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