Ectopic parathyroid adenoma localized with MIBI scintigraphy and excised with guide of macroaggregated human serum albumin injection.

Abstract

Primary hyperparathyroidism is caused by an excessive amount of parathyroid hormone secreted by one or more enlarged parathyroid glands. Most commonly primary hyperparathyroidism is caused by a parathyroid adenoma. Ectopic parathyroid adenomas are rare, but they can complicate the surgical treatment and have an increased morbidity and poorer success rate. Thus, preoperative imaging is particularly valuable in this group of patients with hyperparathyroidism. Preoperative imaging has opened up a new era of minimally invasive parathyroid surgery procedures. The radioguided occult lesion localization technique has become the preferred approach to preoperative localization of nonpalpable breast lesions in several breast units. In this report, we investigated the usefulness of the radio-guided occult lesion localization technique in the identification of ectopic parathyroid adenomas. We describe the case of a 66-year-old woman who was diagnosed to be hypercalcemic. Tc-99m methoxy-isobutyl-isonitrile scintigraphy identified an ectopic parathyroid adenoma. The patient's cervical region was scanned with the probe to localize an area of maximal radiotracer uptake and the hot area was identified by a gamma probe. Careful dissection was then carried out and an enlarged ectopic parathyroid gland was removed. In conclusion, the preoperative imaging of an ectopic parathyroid adenoma and the excision of this tissue with radioguided occult lesion localization technique can open up a new era of minimally invasive parathyroid surgery.