BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the h...BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction.Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.展开更多
We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, ...We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, cystic neck masses in adults. A 72 year old female presented to a tertiary academic medical center with a complicated past medical history and was found to have an asymptomatic central neck mass which measured 10.5 × 7.7 × 4.1 cm on ultrasound and extended from the retropharyngeal space with mass effect on the hypopharynx, esophagus, trachea, and right carotid space structures as well as the superior mediastinum. She had elevated calcium and parathyroid hormone (PTH) levels. She underwent surgical excision of this mass and had an uneventful postoperative period. Large cystic neck masses generate a wide differential diagnosis. In adults, it is important to consider the rare possibility of parathyroid adenoma, especially in patients who may not be able to communicate vague symptoms of hypercalcemia. This particular parathyroid adenoma is several orders of magnitude larger than an average parathyroid adenoma and its massive size served as a distraction for the proper diagnosis as large, cystic neck masses in adults are to be considered cancer until proven otherwise.展开更多
BACKGROUND Parathyroid adenoma is a benign parathyroid tumor,with serum parathyroid hormone and calcium ion concentrations as the typical basis for diagnosis.Its clinical manifestations are complex and changeable;thus...BACKGROUND Parathyroid adenoma is a benign parathyroid tumor,with serum parathyroid hormone and calcium ion concentrations as the typical basis for diagnosis.Its clinical manifestations are complex and changeable;thus it is easily missed or misdiagnosed.Approximately 85%of patients with parathyroid adenoma develop primary hyperparathyroidism,and abnormalities in bones,kidneys and other organs can occur.Brown tumors are rare.CASE SUMMARY We report a rare case of fibrocystic osteitis associated with a parathyroid adenoma,which was discovered by chance due to a rib tumor.Abnormally elevated serum parathyroid hormone and calcium ion were found before surgery.We suspected primary hyperparathyroidism,and color Doppler ultrasound suggested the presence of a thyroid mass.With informed consent by the patient and her family,we first removed the rib tumor,and one week later,resection of the parathyroid adenoma and thyroid mass was performed on both sides,and the patient recovered well after surgery.CONCLUSION In the case of parathyroid adenoma combined with brown tumor,the bone cyst will gradually decrease in size with time without treatment.If not,surgery should be performed as soon as possible.展开更多
BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-yea...BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy.She was diagnosed with parathyroidoma,papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically.Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy.The healthy infant was delivered at the 40th week of pregnancy.The mother had no evidence of recurrence over three years of follow-up.CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.展开更多
BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgi...BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.展开更多
<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</str...<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</strong> The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. <strong>Results:</strong> The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). <strong>Conclusion: </strong>Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.展开更多
Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to d...Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.展开更多
Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound a...Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound and scintigraphy combination. Difficulties can appear. If the gland is not located in a cervical position and has no uptake in scintigraphy but there is high suspition of an adenoma causing the PHPT, some extra tests should be considered. Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy. We report the CT scan and the magnetic resonance imaging (MRI) images that show the tumour. It was surgically resected by a cervical approach. After the excision, the patient recovered normal levels of Calcium and Parathormone (PTH). Conclusion: We review literature about cystic and mediastinal adenomas and diagnostic methods when the standard ones do not give an accurate localization diagnosis.展开更多
Parathyroid adenoma classically presents symptoms of hypercalcaemia. Here, we present a case of a rare presentation of a parathyroid adenoma in a young male patient with a pathological fracture.
Introduction: Mediastinal parathyroid adenoma localization is a rare entity. We report a case of excision by manubriotomy of intrathymic parathyroid adenoma detected by Computed Tomography scan of the chest and neck a...Introduction: Mediastinal parathyroid adenoma localization is a rare entity. We report a case of excision by manubriotomy of intrathymic parathyroid adenoma detected by Computed Tomography scan of the chest and neck and confirmed by Technetium-99 m-sestamibi scan (99 mTc-MIBI). Case Presentation: A 68 years old woman with history of hypercalcaemia, PTH elevation and operation for pathological fracture of the left femur 7 days before was presented to our service. The patient underwent manubriotomy and the adenoma was found within the right lobe of the thymus gland. Conclusion: The Technetium-99 m-sestamibi scan evaluation can be useful in the preoperative localization of ectopic parathyroid adenomas. The surgical approach by manubriotomy is privileged when the ectopic adenoma is in the upper part of anterior mediastinum.展开更多
BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the ...BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the individual tumor and the degree of hypercalcemia.CASE SUMMARY The aim of this report is to summarize the diagnosis and treatment of three cases of PC and to review and conclude aspects regarding the three collected cases with reference to other relevant cases to explore the value of ultrasound in the diagnosis of PC.All three patients had hypercalcemia,consisting of a high serum calcium level and a high level of parathyroid hormone that was>2-fold(even>30-fold)of the normal upper limit.The ultrasonographic findings of the parathyroid gland showed that the glands were all>30 mm,and the internal echo was uneven.All patients underwent surgery.PC in three cases was confirmed by routine histopathology and immunohistochemistry.CONCLUSION As clinical signs and laboratory results are nonspecific,it is difficult to diagnose PC preoperatively,so imaging examinations are often needed.展开更多
The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurat...The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration.The common causes include solitary parathyroid adenoma,multiple parathyroid adenomas,parathyroid hyperplasia and parathyroid carcinoma.It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging.The various imaging modalities available include high resolution ultrasound of the neck,nuclear imaging studies,four-dimensional computed tomography(4D CT)and magnetic resonance imaging.Contrast enhanced ultrasound is a novel technique which has been recently added to the armam-entarium to differentiate between parathyroid adenomas and its mimics.Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.展开更多
We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially th...We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very uncommon.The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been proposed.It is important to treat the provoking factor.Therefore,the cause of hypercalcemia should be identif ied early.Surgical resection of the parathyroid adenoma is the ultimate therapy.展开更多
BACKGROUND Primary hyperparathyroidism(PHPT)is the most common cause of pregnancyrelated hypercalcemia.PHPT can cause maternal and fetal complications in pregnant women.General anesthesia for non-obstetric surgery in ...BACKGROUND Primary hyperparathyroidism(PHPT)is the most common cause of pregnancyrelated hypercalcemia.PHPT can cause maternal and fetal complications in pregnant women.General anesthesia for non-obstetric surgery in pregnant women is associated with maternal hazards and concerns regarding long-term neonatal neurocognitive effects.Surgical removal of the lesion in mid-pregnancy is currently the primary treatment option for pregnant patients with PHPT.However,the blood calcium concentration at which surgery should be considered remains under discussion due to the risk of miscarriage.CASE SUMMARY A 31-year-old nulliparous woman at 11 wk of gestation was admitted to our hospital for parathyroidectomy.The patient had a history of intrauterine fetal death with unknown etiology at 16 wk of gestation 1 year prior.Her blood test results showed that the serum calcium level was elevated to 12.9 mg/dL,and the parathyroid hormone level was elevated to 157 pg/mL.In a neck ultrasound,it revealed a 0.8 cm×1.5 cm sized oval,hypoechoic mass in the upper posterior of the left thyroid gland,which was compatible with parathyroid adenoma.Superficial cervical plexus block(SCPB)for parathyroidectomy was performed.After surgery,the obstetrician checked the status of the fetus,and there were no abnormal signs.Since then her calcium level returned to normal values after one week of surgery and a healthy male neonate of 2910 g was delivered vaginally at 38 wk of gestation.CONCLUSION Our case suggests that SCPB can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.展开更多
Background: Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased fro...Background: Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased from 0.1% to 0.4% worldwide. The only curative treatment is parathyroidectomy. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are cervical ultrasonography (US) and/or Sestamibi scintigraphy. Objectives: To describe the accuracy of US and Sestamibi for detection of hyperfunctioning parathyroid adenomas preoperatively in patients with confirmed pHPT from our medical institution. Results: This is a retrospective study from a prospectively kept database that included thirty-one patients with the confirmed diagnosis of pHPT clinically and biochemically. The average age was 57.8 years old. Preoperative US and surgery findings were compared with a sensitivity of 51%. Preoperative Sestamibi and surgery findings were compared resulting in a sensitivity of 71%. Both imaging methods combined, resulted in a sensitivity of 80%. Conclusion: In patients with pHPT, Sestamibi is an effective method for localizing parathyroid pathology preoperatively, but the false negative rate can be high. US tends to have a wider range explained by the operator-dependent factor. The combination of US and Sestamibi reduces the rate of false negatives, as reported in international literature. It is important to mention that these studies cannot be used as a confirmatory test for this disease. It should only be used as an adjunct to help plan the operation.展开更多
Advances in preoperative localization studies and de-mands for scarless surgery have promoted the inves-tigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most co...Advances in preoperative localization studies and de-mands for scarless surgery have promoted the inves-tigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral ves-tibular parathyroidectomy(RTVP) in four patients with primary hyperparathyroidism. The surgery was perfor-med with the Da Vinci system through three trocars intro-duced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.展开更多
基金Supported by Key Clinical Projects of Peking University Third Hospital,No. BYSYZD2021013Beijing Haidian District Innovation and transformation project,No. HDCXZHZB2021202。
文摘BACKGROUND Cervical haemorrhage due to spontaneous rupture of a parathyroid adenoma is a rare complication that may cause life-threatening acute airway compromise.CASE SUMMARY A 64-year-old woman was admitted to the hospital 1 day after the onset of right neck enlargement, local tenderness, head-turning difficulty, pharyngeal pain, and mild dyspnoea. Repeat routine blood testing showed a rapid decrease in the haemoglobin concentration, indicating active bleeding. Enhanced computed tomography images showed neck haemorrhage and a ruptured right parathyroid adenoma. The plan was to perform emergency neck exploration, haemorrhage removal, and right inferior parathyroidectomy under general anaesthesia. The patient was administered 50 mg of intravenous propofol, and the glottis was successfully visualised on video laryngoscopy. However, after the administration of a muscle relaxant, the glottis was no longer visible and the patient had a difficult airway that prevented mask ventilation and endotracheal intubation. Fortunately, an experienced anaesthesiologist successfully intubated the patient under video laryngoscopy after an emergency laryngeal mask placement. Postoperative pathology showed a parathyroid adenoma with marked bleeding and cystic changes. The patient recovered well without complications.CONCLUSION Airway management is very important in patients with cervical haemorrhage. After the administration of muscle relaxants, the loss of oropharyngeal support can cause acute airway obstruction.Therefore, muscle relaxants should be administered with caution. Anaesthesiologists should pay careful attention to airway management and have alternative airway devices and tracheotomy equipment available.
文摘We present a case report of a parathyroid adenoma, which presented as a giant cystic neck mass while providing thorough reviews of the pathophysiology of parathyroid adenomas and the differential diagnosis for large, cystic neck masses in adults. A 72 year old female presented to a tertiary academic medical center with a complicated past medical history and was found to have an asymptomatic central neck mass which measured 10.5 × 7.7 × 4.1 cm on ultrasound and extended from the retropharyngeal space with mass effect on the hypopharynx, esophagus, trachea, and right carotid space structures as well as the superior mediastinum. She had elevated calcium and parathyroid hormone (PTH) levels. She underwent surgical excision of this mass and had an uneventful postoperative period. Large cystic neck masses generate a wide differential diagnosis. In adults, it is important to consider the rare possibility of parathyroid adenoma, especially in patients who may not be able to communicate vague symptoms of hypercalcemia. This particular parathyroid adenoma is several orders of magnitude larger than an average parathyroid adenoma and its massive size served as a distraction for the proper diagnosis as large, cystic neck masses in adults are to be considered cancer until proven otherwise.
文摘BACKGROUND Parathyroid adenoma is a benign parathyroid tumor,with serum parathyroid hormone and calcium ion concentrations as the typical basis for diagnosis.Its clinical manifestations are complex and changeable;thus it is easily missed or misdiagnosed.Approximately 85%of patients with parathyroid adenoma develop primary hyperparathyroidism,and abnormalities in bones,kidneys and other organs can occur.Brown tumors are rare.CASE SUMMARY We report a rare case of fibrocystic osteitis associated with a parathyroid adenoma,which was discovered by chance due to a rib tumor.Abnormally elevated serum parathyroid hormone and calcium ion were found before surgery.We suspected primary hyperparathyroidism,and color Doppler ultrasound suggested the presence of a thyroid mass.With informed consent by the patient and her family,we first removed the rib tumor,and one week later,resection of the parathyroid adenoma and thyroid mass was performed on both sides,and the patient recovered well after surgery.CONCLUSION In the case of parathyroid adenoma combined with brown tumor,the bone cyst will gradually decrease in size with time without treatment.If not,surgery should be performed as soon as possible.
文摘BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy.She was diagnosed with parathyroidoma,papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically.Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy.The healthy infant was delivered at the 40th week of pregnancy.The mother had no evidence of recurrence over three years of follow-up.CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.
文摘BACKGROUND Parathyroid adenoma(PA) sometimes recurs after surgery,how to improve the surgical success rate of PA is the key to the treatment of this disease.AIM To investigate the clinical features,diagnosis,and surgical treatment of patients with PA.METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study.The clinical features,localization diagnosis,and surgical treatment of these patients were analyzed.RESULTS Of the 140 patients,32 were male and 108 were female;132 cases had one adenoma,and 8 had two adenomas.In addition,114 cases had clinical symptoms,among which 51,28,23,8,and 4 had urinary system,skeletal system,digestive system,neuromuscular system,and neuropsychiatric symptoms,respectively,while 26 cases had no obvious symptoms.The median level of preoperative parathyroid hormone(PTH) was 201.0 pg/m L.The positive detection rate of technetium-99m sestamibi(Tc-99m MIBI) single-photon emission computed tomography/computed tomography(SPECT/CT),ultrasound examination,and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%,85.5%,and 96.4%,respectively.Open surgery was performed in all patients,and PTH was monitored during surgery.The success rate of surgery was 98.6%.After surgery,21 cases developed hypocalcemia,1 case developed temporary hoarseness,and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism,postoperative hemorrhage,or hematoma in the surgical area.CONCLUSION For patients with clinically unexplained skeletal system,urinary system,and neuropsychiatric symptoms,the possibility of PA should be considered.Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis.Precise preoperative localization,intraoperative PTH monitoring,and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.
文摘<strong>Objective:</strong> To compare the clinical efficacy and safety of ultrasound-guided microwave ablation with surgery for the treatment of primary parathyroid adenoma. <strong>Methods:</strong> The clinical data of patients with primary parathyroid adenoma admitted to the First Hospital of Yangtze University from January 2010 to May 2020 were retrospectively analyzed, and they were divided into 43 cases in the microwave ablation group (MWA) and 39 cases in the surgical procedure group (SR) according to the different treatment methods. The surgical condition, postoperative complications, and changes in serum parathyroid hormone (PTH) and serum calcium and phosphorus levels were analyzed in both groups. <strong>Results:</strong> The hospital stay and operation time of patients in the microwave ablation group were shorter than those in the surgical group, and the intraoperative bleeding was significantly less than that in the surgical group (P < 0.05);the serum parathyroid hormone (PTH), blood calcium and blood phosphorus levels of patients in both groups were significantly lower than those before treatment (P < 0.05) after surgery of 1, 3 and 6 months respectively, and the differences between groups were not statistically significant (P > 0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). <strong>Conclusion: </strong>Microwave ablation can achieve the same therapeutic effect as surgery. It is a safe and feasible clinical technique worthy of clinical promotion with its short hospitalization time, less bleeding and less trauma.
基金Supported by the Key Project of Scientific and Technological Innovation in Hangzhou,NO.20131813A08the Key Project of Medical Scientific and Technology Program in Hangzhou,NO.2013Z04+1 种基金the Traditional Chinese Medical Science Research Program of Zhejiang Province,NO.2018239534the Applied Research Project of Commonweal Technology in Zhejiang Province,NO.2017C33180
文摘Primary hyperparathyroidism(PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.
文摘Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound and scintigraphy combination. Difficulties can appear. If the gland is not located in a cervical position and has no uptake in scintigraphy but there is high suspition of an adenoma causing the PHPT, some extra tests should be considered. Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy. We report the CT scan and the magnetic resonance imaging (MRI) images that show the tumour. It was surgically resected by a cervical approach. After the excision, the patient recovered normal levels of Calcium and Parathormone (PTH). Conclusion: We review literature about cystic and mediastinal adenomas and diagnostic methods when the standard ones do not give an accurate localization diagnosis.
文摘Parathyroid adenoma classically presents symptoms of hypercalcaemia. Here, we present a case of a rare presentation of a parathyroid adenoma in a young male patient with a pathological fracture.
文摘Introduction: Mediastinal parathyroid adenoma localization is a rare entity. We report a case of excision by manubriotomy of intrathymic parathyroid adenoma detected by Computed Tomography scan of the chest and neck and confirmed by Technetium-99 m-sestamibi scan (99 mTc-MIBI). Case Presentation: A 68 years old woman with history of hypercalcaemia, PTH elevation and operation for pathological fracture of the left femur 7 days before was presented to our service. The patient underwent manubriotomy and the adenoma was found within the right lobe of the thymus gland. Conclusion: The Technetium-99 m-sestamibi scan evaluation can be useful in the preoperative localization of ectopic parathyroid adenomas. The surgical approach by manubriotomy is privileged when the ectopic adenoma is in the upper part of anterior mediastinum.
文摘BACKGROUND Parathyroid carcinoma(PC)is a rare,slow-growing malignant tumor and a rare cause of primary hyperfunctioning of the parathyroid,with a highly variable clinical course,depending on the aggressiveness of the individual tumor and the degree of hypercalcemia.CASE SUMMARY The aim of this report is to summarize the diagnosis and treatment of three cases of PC and to review and conclude aspects regarding the three collected cases with reference to other relevant cases to explore the value of ultrasound in the diagnosis of PC.All three patients had hypercalcemia,consisting of a high serum calcium level and a high level of parathyroid hormone that was>2-fold(even>30-fold)of the normal upper limit.The ultrasonographic findings of the parathyroid gland showed that the glands were all>30 mm,and the internal echo was uneven.All patients underwent surgery.PC in three cases was confirmed by routine histopathology and immunohistochemistry.CONCLUSION As clinical signs and laboratory results are nonspecific,it is difficult to diagnose PC preoperatively,so imaging examinations are often needed.
文摘The goal of parathyroid imaging in hyperparathyroidism is not diagnosis,rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach.Hence,the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration.The common causes include solitary parathyroid adenoma,multiple parathyroid adenomas,parathyroid hyperplasia and parathyroid carcinoma.It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging.The various imaging modalities available include high resolution ultrasound of the neck,nuclear imaging studies,four-dimensional computed tomography(4D CT)and magnetic resonance imaging.Contrast enhanced ultrasound is a novel technique which has been recently added to the armam-entarium to differentiate between parathyroid adenomas and its mimics.Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.
文摘We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a known medical entity,it is very uncommon.The pathophysiology of hypercalcemia-induced acute pancreatitis is therefore not well known,although some mechanisms have been proposed.It is important to treat the provoking factor.Therefore,the cause of hypercalcemia should be identif ied early.Surgical resection of the parathyroid adenoma is the ultimate therapy.
文摘BACKGROUND Primary hyperparathyroidism(PHPT)is the most common cause of pregnancyrelated hypercalcemia.PHPT can cause maternal and fetal complications in pregnant women.General anesthesia for non-obstetric surgery in pregnant women is associated with maternal hazards and concerns regarding long-term neonatal neurocognitive effects.Surgical removal of the lesion in mid-pregnancy is currently the primary treatment option for pregnant patients with PHPT.However,the blood calcium concentration at which surgery should be considered remains under discussion due to the risk of miscarriage.CASE SUMMARY A 31-year-old nulliparous woman at 11 wk of gestation was admitted to our hospital for parathyroidectomy.The patient had a history of intrauterine fetal death with unknown etiology at 16 wk of gestation 1 year prior.Her blood test results showed that the serum calcium level was elevated to 12.9 mg/dL,and the parathyroid hormone level was elevated to 157 pg/mL.In a neck ultrasound,it revealed a 0.8 cm×1.5 cm sized oval,hypoechoic mass in the upper posterior of the left thyroid gland,which was compatible with parathyroid adenoma.Superficial cervical plexus block(SCPB)for parathyroidectomy was performed.After surgery,the obstetrician checked the status of the fetus,and there were no abnormal signs.Since then her calcium level returned to normal values after one week of surgery and a healthy male neonate of 2910 g was delivered vaginally at 38 wk of gestation.CONCLUSION Our case suggests that SCPB can be an anesthetic option for parathyroidectomy during the first trimester of pregnancy.
文摘Background: Primary hyperparathyroidism (pHPT) is one of the most common endocrine diseases and the most common cause of hypercalcemia. Since routine laboratory testing, the prevalence of the disease has increased from 0.1% to 0.4% worldwide. The only curative treatment is parathyroidectomy. Nowadays, preoperative localization studies have become standard before surgical treatment, and the first stage imaging methods are cervical ultrasonography (US) and/or Sestamibi scintigraphy. Objectives: To describe the accuracy of US and Sestamibi for detection of hyperfunctioning parathyroid adenomas preoperatively in patients with confirmed pHPT from our medical institution. Results: This is a retrospective study from a prospectively kept database that included thirty-one patients with the confirmed diagnosis of pHPT clinically and biochemically. The average age was 57.8 years old. Preoperative US and surgery findings were compared with a sensitivity of 51%. Preoperative Sestamibi and surgery findings were compared resulting in a sensitivity of 71%. Both imaging methods combined, resulted in a sensitivity of 80%. Conclusion: In patients with pHPT, Sestamibi is an effective method for localizing parathyroid pathology preoperatively, but the false negative rate can be high. US tends to have a wider range explained by the operator-dependent factor. The combination of US and Sestamibi reduces the rate of false negatives, as reported in international literature. It is important to mention that these studies cannot be used as a confirmatory test for this disease. It should only be used as an adjunct to help plan the operation.
文摘Advances in preoperative localization studies and de-mands for scarless surgery have promoted the inves-tigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral ves-tibular parathyroidectomy(RTVP) in four patients with primary hyperparathyroidism. The surgery was perfor-med with the Da Vinci system through three trocars intro-duced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.
