Rusnak Aaron J, Ryan Simon A, Boeddinghaus Rudolf, Lee Trenton K, Leonard Niamh M, Stuckey Bronwyn G A
Department of Surgery, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
Hollywood Private Hospital, Nedlands, WA 6009, Australia.
JCEM Case Rep. 2025 May 29;3(7):luaf108. doi: 10.1210/jcemcr/luaf108. eCollection 2025 Jul.
A 53-year-old female patient was incidentally found to have asymptomatic hypercalcemia, later diagnosed due to primary hyperparathyroidism (PHPT): ionized calcium 6.48 mg/dL (SI: 1.62 mmol/L) (reference range, 4.48-5.28 mg/dL [SI: 1.12-1.32 mmol/L]); total calcium 12.08 mg/dL (SI: 3.02 mmol/L) (reference range, 8.8-10.4 mg/dL [SI: 2.20-2.60 mmol/L]); and parathyroid hormone (PTH) 184.8 pg/mL (SI: 19.6 pmol/L) (reference range, 15-85 pg/mL [SI: 1.6-9.0 pmol/L]). Preoperatively, standard imaging modalities, including ultrasound (US), four-dimensional computed tomography (4DCT) and dual radiolabeled technetium-99 pertechnetate and sesta-methoxyisobutylisonitrile with single photon emission computed tomography (Tc-MIBI SPECT/CT), failed to localize a parathyroid adenoma. The patient underwent cervical exploration and parathyroidectomy where 4 orthotopic glands were identified, removing 2 mildly enlarged right-sided parathyroid glands and marking the 2 left-sided parathyroids with clip and suture; however, postoperative hypercalcemia persisted. Subsequent F-fluorocholine positron emission tomography/computed tomography (F-FCH PET/CT) localized an intrathyroidal parathyroid adenoma. Fine needle aspiration (FNA) confirmed parathyroid tissue, and the patient underwent a right hemithyroidectomy, with biochemical cure. This case highlights the diagnostic and management challenges of an intrathyroidal fifth parathyroid adenoma causing PHPT, underscores potential pitfalls localizing parathyroid adenomas, and discusses the usefulness of F-FCH PET/CT imaging in challenging cases.
一名53岁女性患者偶然发现无症状高钙血症，随后因原发性甲状旁腺功能亢进症（PHPT）确诊：离子钙6.48 mg/dL（国际单位制：1.62 mmol/L）（参考范围，4.48 - 5.28 mg/dL [国际单位制：1.12 - 1.32 mmol/L]）；总钙12.08 mg/dL（国际单位制：3.02 mmol/L）（参考范围，8.8 - 10.4 mg/dL [国际单位制：2.20 - 2.60 mmol/L]）；甲状旁腺激素（PTH）184.8 pg/mL（国际单位制：19.6 pmol/L）（参考范围，15 - 85 pg/mL [国际单位制：1.6 - 9.0 pmol/L]）。术前，包括超声（US）、四维计算机断层扫描（4DCT）以及锝 - 99高锝酸盐和甲氧基异丁基异腈双标记单光子发射计算机断层扫描（Tc - MIBI SPECT/CT）在内的标准成像方式均未能定位甲状旁腺腺瘤。患者接受了颈部探查和甲状旁腺切除术，术中发现4个正常位置的腺体，切除了2个右侧轻度肿大的甲状旁腺，并用夹子和缝线标记了2个左侧甲状旁腺；然而，术后高钙血症仍持续存在。随后，F - 氟胆碱正电子发射断层扫描/计算机断层扫描（F - FCH PET/CT）定位到了甲状腺内的甲状旁腺腺瘤。细针穿刺抽吸活检（FNA）证实为甲状旁腺组织，患者接受了右侧甲状腺叶切除术，并实现了生化治愈。该病例突出了导致PHPT的甲状腺内第五个甲状旁腺腺瘤的诊断和管理挑战，强调了定位甲状旁腺腺瘤时的潜在陷阱，并讨论了F - FCH PET/CT成像在疑难病例中的作用。
Zotero 插件
