Endocrine Abstracts

Background: Primary hyperparathyroidism (PHPT) is nowadays an asymptomatic disease characterized by mild hypercalcemia and elevated parathormone (PTH) levels. PHPT is caused by parathyroid adenoma in 80–85% of patiens, up to 20% are located ectopically and therefore an ultrasound investigation is not helpful. SPECT sestamibi or tetrofosmin scintigraphy of the neck and thorax is considered to be the optimal method for the evaluation of ectopic parathyroid adenoma.

Case presentation: We report a case of 62-year old female patient with history of left thyroid lobectomy in 2003 presenting with back pain. Biochemical investigations confirmed primary hyperparathyroidism with reduced bone density (T score: −1.6) Ultrasound examination was unsuccesful. Tc-tetrofosmin parathyroid scan and SPECT of the neck and thorax showed uptake of radiotracer in retroesophageal space. In february 2008 patient underwent primary operation without success. Biochemically sinificant hypercalcemia (Ca 3 mmol/l per N: 2.25–2.75 mmol/l/, Ca²⁺1.53 mmol/l per N: 0.9–1.3 mmol/l/) with elevated intact PTH level (206 pg/ml per N: 9–72 pg/ml/) persisted until the radionavigated neck exploration. Perioperative histological study confirmed parathyroid adenoma. Definitive histology revealed a 32×15×10 mm parathyroid adenoma. After surgery the patient was normocalcemic with a normal intact PTH levels.

Conclusion: We report a role of preoperative scintigraphic and intraoperative scintimetric localisation and confirmation of an ectopic parathyroid adenoma and their positive impact on the parathyroidectomy success.