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KMID : 0356620120270010083
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Journal of Korean Society of Endocrinology
2012 Volume.27 No. 1 p.83 ~ p.88
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Primary Hyperaparathyroidism due to Cystic Parathyroid Adenoma not Detected on 99mTc-Sestamibi Scan
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Kang Ah-Reum
Kim Eun-Ki
Nam Eun-Young
Byun Sun-Ju
Kim Jung-Hee
Ohn Jung-Hun
Hong Eun-Shil
Choi Hyung-Jin
Chung Kyung-Chun
Sung Myung-Whun
Shin Chan-Soo
Park Kyong-Soo
Kim Seong-Yeon
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Abstract
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Parathyroid cysts, which can be divided into functional and non-functional cysts, are rare causes of primary hyperparathyroidism. A technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi) parathyroid scan is a sensitive diagnostic tool for the localization, although it sometimes shows a false-negative result. Here we report a case of presumed cystic parathyroid adenoma based on clinical findings and analysis of cystic fluid with negative findings in a parathyroid scan. A 44-year-old male patient visited the hospital due to leg pain and compressive symptoms (dysphagia, hoarseness) that had started 4-5 months before. His serum calcium level was 14.4 mg/dL and his intact parathyroid hormone (iPTH) had increased to 478.1 pg/mL. On neck computed tomography, a cystic nodule measuring 6.2 cm was detected in the inferior part of the right thyroid gland. Sestamibi uptake for this nodule was not detected on 2-h delayed imaging, and fluorodeoxyglucose positron emission tomography showed only subtle uptake. Fine-needle aspiration was performed and intracystic iPTH had increased to 61,600 pg/mL. Focused parathyroidectomy guided by intraoperative iPTH monitoring led to successful enucleation of the right inferior parathyroid gland. A parathyroid adenoma was confirmed, and his laboratory results had normalized. This study shows that cystic parathyroid adenoma can sometimes be difficult to detect on a 99mTc-sestamibi parathyroid scan.
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KEYWORD
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Hyperparathyroidism, Parathyroid neoplasms, Technetium Tc 99m sestam
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