Title: Unique Clinical Characteristics of Primary Hyperparathyroidism and Role of Nuclear Medicine Imaging
Authors: Amit Sharma, Anurag Jain, Sumit Agarwal, IP Dubey, Rajeev Kumar , Braj Kishore, MS Chauhan, AG Pandit, Arun Ravi John, MG Vishnoi, Dharmesh Paliwal
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.134
Abstract
Primary hyperparathyroidism (PHPT) has a variable clinical expression. Symptomatic PHPT is still the predominant form of the disease in many parts of the world, especially developing countries. Because the clinical profile of the disease has changed from that described in the past, we sought to improve our understanding of the disease in patients with unusual presentations and role of nuclear medicine imaging.
Materials and Methods- We summarized the clinical presentation, biochemical, Nuclear medicine imaging and radiological features from the case records in the last six months of 7 patients at the apex hospital of Armed Forces (AHRR) who had documented as PHPT.
Results: N=7 (M2, F5), Mean age: 61.2 ± 14.6 years (38-76). Various clinical presentations as: Bony swelling, features of hypecalcaemia, recurrent kidney stones, recurrent fractures, osteoporosis, incidentaloma in USG neck.
Torsades – de – pointes, multiglandular disease, Isolated Osteitis Fibrosa Cystica left maxilla and concurrent Paget’s disease were unusual clinical characteristics.
99mTc MIBI scan was able to localize parathyroid adenoma in 5 out of 7 patients. Both USG and MIBI scan was not able to localize the lesion in one patient. In one patient MIBI scan does not localize the adenoma, however ultrasound (USG) reveals three hypoechoic lesions. 99mTc Methylene Diphosphonate (MDP) scan was done in 2 patients. Isolated bone lesion was detected in one patient and metabolic super scan was detected in another.
Conclusion: PHPT can have varied presentations. It continues to be a symptomatic disorder with skeletal and renal manifestation at younger age groups in India. MIBI parathyroid imaging is the most sensitive imaging modality in preoperative management. Additional single-photon emission computed tomography to planar scintigraphy provides information for localizing parathyroid lesions, to differentiate thyroid from parathyroid lesions. MIBI imaging is having limited role in multiglandular disease.
