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Wu C, Zhu B, Kang S, Wang S, Liu Y, Mei X, Zhang H, Jiang S. Ultrasound characteristics of normal parathyroid glands and analysis of the factors affecting their display. BMC Med Imaging 2024; 24:42. [PMID: 38350842 PMCID: PMC10863184 DOI: 10.1186/s12880-024-01214-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Parathyroid glands are important endocrine glands, and the identification of normal parathyroid glands is crucial for their protection. The aim of this study is to explore the sonographic characteristics of normal parathyroid glands and analyze the factors affecting their display. METHODS Seven hundred three subjects who underwent physical examination at our hospital were included. The number, location, size, morphology, echogenicity and blood flow distribution of parathyroid glands were recorded. The ultrasound characteristics and display rate were also summarized. Meanwhile, shear wave elastography was performed in 50 cases to provide the stiffness measurements, and 26 cases received contrast-enhanced ultrasonography for the assessment of microcirculatory perfusion. Furthermore, we analyzed the factors affecting parathyroid display, including basic information of the subjects and ultrasound features of the thyroid. RESULTS ① A total of 1038 parathyroid glands were detected, among which, 79.29% were hyperechoic, 20.71% were isoechoic, 88.15% were oval-shaped, and 86.71% had blood flow of grade 0-I. ② 81.79% of the subjects had at least one parathyroid gland detected. ③ The Emean, Emax, PI and AUC of the parathyroid glands were significantly lower than those of the adjacent thyroid tissue (P < 0.05). ④ The display of normal parathyroid glands was related to BMI, thyroid echogenicity and thyroid volume of the subjects (P < 0.05). CONCLUSIONS Normal parathyroid glands tend to appear as oval-shaped hyperechoic nodules with blood flow of grade 0-I. BMI, thyroid echogenicity and thyroid volume are independent factors affecting the display of parathyroid glands.
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Affiliation(s)
- Cuiping Wu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, 146 Baojian Road, Harbin City, Heilongjiang Province, China
| | - Binyang Zhu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, 146 Baojian Road, Harbin City, Heilongjiang Province, China
| | - Song Kang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, 146 Baojian Road, Harbin City, Heilongjiang Province, China
| | - Shiyu Wang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, 146 Baojian Road, Harbin City, Heilongjiang Province, China
| | - Yingying Liu
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, 146 Baojian Road, Harbin City, Heilongjiang Province, China
| | - Xue Mei
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, 146 Baojian Road, Harbin City, Heilongjiang Province, China
| | - He Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, 146 Baojian Road, Harbin City, Heilongjiang Province, China
| | - Shuangquan Jiang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, 146 Baojian Road, Harbin City, Heilongjiang Province, China.
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Vasandani N. Utility of 99mTc-Sestamibi Single-Photon Emission Computed Tomography (SPECT)/CT Single Imaging Strategy in the Preoperative Localization of Parathyroid Adenoma. Cureus 2024; 16:e51828. [PMID: 38192532 PMCID: PMC10772353 DOI: 10.7759/cureus.51828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 01/10/2024] Open
Abstract
Background Primary hyperparathyroidism is an endocrinopathy associated with dysregulated calcium homeostasis. The most common etiology is a parathyroid adenoma most definitely managed via a parathyroidectomy. The two main surgical approaches include a minimally invasive parathyroidectomy (MIP) and open four-gland exploration (4-GE). MIP is the preferred operative strategy since it is associated with less postoperative complications. Accurate preoperative imaging is essential in informing the optimal approach to surgery. MIP is only considered if adenoma is able to be localized precisely. The most commonly used imaging modality includes ultrasound and sestamibi single-photon emission computed tomography (SPECT)/CT, either as a single or combination strategy. Other options include MRI, PET, and 4D CT. There is no universally accepted preoperative imaging strategy. The literature is discordant and recommendations proposed by existing guidelines are incongruous. Objectives This study aimed to evaluate currently utilized preoperative parathyroid imaging modalities at our institution and correlate them with surgical and histological findings to determine the most efficient imaging strategy to detect adenomas for our patient cohort. This will ultimately guide the best surgical approach for patients receiving parathyroidectomies. Methods This is a retrospective observational study of all patients undergoing first-time surgery for biochemically proven primary hyperparathyroidism at our institution over the past five years. Multiple data points were collected including modality of preoperative disease localization, operation type, final histopathology, biochemical investigations, and cure rate. Patients were categorized into one of three groups based on the method of disease localization. Results A total of 244 patients had parathyroidectomies performed at our institution in the past five years from January 2018 to December 2022. Ninety-six percent (n=235) of all patients received dual imaging preoperatively with SPECT/CT and ultrasound performed on the same day and therefore included in this study. A total of 64.3% (n=151) underwent MIP. Eighty percent (n=188) of all histopathology revealed adenomas and 26.8% (n=63) of patients had adenoma localized on SPECT/CT only (sensitivity: 58.1%, specificity: 71%, and positive predictive value {PPV}: 85.7%). A total of 9.8% (n=23) had adenoma localized on ultrasound only (sensitivity: 15.6%, specificity: 73.3%, and PPV: 65.2%). A total of 45.1% (n=106) were dual localized on both SPECT/CT and ultrasound (sensitivity: 75.6%, specificity: 46.6%, and PPV: 84.9%). The cure rate was 91.5% in the dual-localized group, 86% in the dual-unlocalized group, and 96.5% when localized with SPECT/CT alone. Conclusion A dual-imaging modality with SPECT/CT and ultrasound should remain the first-line imaging strategy. This approach has higher sensitivity rates and poses no inherent patient or surgical-related risks. Patients with disease unlocalized on SPECT/CT alone had a positive predictive value, specificity, and likelihood ratio for adenoma detection comparable to dual-localized patients. Therefore, SPECT/CT alone is sufficient for directing MIP in the presence of a negative ultrasound.
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Wazzan M. Absolute and Relative Washout Rates Associated With Parathyroid Adenoma. Cureus 2023; 15:e48947. [PMID: 38024058 PMCID: PMC10655491 DOI: 10.7759/cureus.48947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Parathyroid adenoma is a benign parathyroid gland tumor that causes excessive parathyroid hormone production, leading to primary hyperparathyroidism. High serum calcium levels characterize it. Accurate diagnosis and localization of adenomas are crucial for effective surgical management. Computed tomography is a fundamental imaging technique used to identify and characterize parathyroid adenomas. This study aimed to provide a comprehensive overview of the absolute and relative contrast washout rates of parathyroid adenoma and the thyroid gland, and compare enhancement patterns to establish the absolute and relative washout rates of parathyroid adenoma. Materials & methods This retrospective study analyzes the CT findings of 33 patients with histopathologically proven parathyroid adenomas. All patients with 4D CT scans have been included with no exclusion criteria. The mean attenuation was measured in Hounsfield units for the parathyroid adenoma and thyroid gland in the non-enhancing, arterial, venous, and delayed phases, depending on the region of interest. All statistical analyses were performed using SPSS (IBM Corp., Armonk, NY, USA). Student's t-test was used to evaluate the differences in measurements between the parathyroid adenoma and thyroid tissue. One-way ANOVA was used to evaluate the difference in calculations between the parathyroid adenoma and thyroid tissue. P-values <0.001 were considered statistically significant. Results The most common location of parathyroid adenomas is inferior to the thyroid gland. The average pre-contrast attenuation of the parathyroid adenoma is 61.8 ± 15.5 HU compared to 105.5 ± 15.2 HU of the thyroid gland. The arterial attenuation of the parathyroid adenoma is 170.3 ± 40.7 HU, relatively comparable to the thyroid gland arterial attenuation, which is 188.0 ± 9.6 HU. The venous and delayed-phase attenuation of the parathyroid adenoma were 146.8 ± 37.5 and 96.8 ± 26.7 HU, respectively, and 178.8 ± 20.2 HU and 149.3 ± 15.2 HU for the thyroid gland, respectively. The calculated absolute and relative arterial washout rates for the parathyroid adenoma were 69.4 ± 13.4% and 43.2 ± 8.0%, respectively, as compared to 46.4 ± 9.9% and 20.6 ± 6.7% for the thyroid gland. The calculated absolute and relative venous washout rates for the parathyroid adenoma were 58.0 ± 21.4% and 33.0 ± 13.7%, respectively, as compared to 37.2 ± 17.2% and 15.9 ± 9.6% for the thyroid gland. Conclusions Parathyroid adenoma demonstrated a significantly higher washout rate than the thyroid gland tissue. Absolute arterial washout ≥69% and relative arterial washout ≥43% indicate parathyroid adenoma. Moreover, absolute venous washout ≥58% and relative venous washout ≥33% can be considered diagnostic factors for parathyroid adenoma. Further, pre-contrast attenuation of <60 Hounsfield units has a substantial predictive value for parathyroid adenoma in addition to the described washout rate. Increased awareness of the washout rate can increase the success rate of four-dimensional computed tomography interpretation.
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Affiliation(s)
- Mohammad Wazzan
- Department of Radiology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Paik W, Lee JC, Noh BJ, Na DG. US Features of the Parathyroid Glands: An Intraoperative Surgical Specimen Study. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:596-605. [PMID: 37324996 PMCID: PMC10265225 DOI: 10.3348/jksr.2022.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/11/2022] [Accepted: 10/08/2022] [Indexed: 06/17/2023]
Abstract
Purpose This study aimed to evaluate the US features of the parathyroid glands (PTGs) using surgical specimens of normal PTGs obtained during thyroid surgery. Materials and Methods This study included 34 normal PTGs from 17 consecutive patients who underwent thyroid surgery between December 2020 and March 2021. All normal PTGs were histologically confirmed by intraoperative frozen-section biopsy for autotransplantation. Surgically resected parathyroid specimens were scanned in sterile normal saline using high-resolution US prior to autotransplantation. The US features of echogenicity (hyperechogenicity or hypoechogenicity), echotexture (homogeneous or heterogeneous), size, and shape (ovoid or round) were retrospectively evaluated. The echogenicity of the three PTGs was compared with that of the thyroid parenchyma of the resected thyroid specimens in two patients. Results All PTGs showed hyperechogenicity similar to that of gauze soaked in normal saline. Homogeneous hyperechogenicity was observed in 32/34 (94.1%) patients, and the echogenicity of the three PTGs was hyperechoic compared with that of the thyroid parenchyma. The long diameter of the PTGs ranged from 5.1 mm to 9.8 mm (mean, 7.1 mm) and the shape of the PTGs was ovoid in 33/34 (97.1%) patients. Conclusion The echogenicity of normal PTG specimens was consistently hyperechoic, and the small ovoid homogeneously hyperechoic structure was a characteristic US feature of the PTGs.
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Piciucchi S, Poletti V. Diffuse pulmonary ill-defined centrilobular opacities: Not only bronchiolitis. Eur J Intern Med 2022; 100:125-126. [PMID: 35346567 DOI: 10.1016/j.ejim.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022]
Affiliation(s)
- S Piciucchi
- Department of Radiology, Ospedale GB Morgagni/University of Bologna, Forlì, Italy.
| | - V Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, DIMES University of Bologna, Forlì; Department of Respiratory Diseases and Allergy, Aarhus University, Aarhus, Denmark
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Lemoine S, Figueres L, Bacchetta J, Frey S, Dubourg L. Calcium homeostasis pathologies in hyperparathyroidism: nephrologic and endocrinologic points of view. ANNALES D'ENDOCRINOLOGIE 2022; 83:237-243. [DOI: 10.1016/j.ando.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Havel M, Dedek V, Kolacek M, Formanek M. Quantitative analysis in parathyroid adenoma scintigraphy. Nucl Med Commun 2022; 43:1-7. [PMID: 34406145 DOI: 10.1097/mnm.0000000000001474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Surgery is the only curative treatment for primary hyperparathyroidism. Parathyroid scintigraphy is one method used to preoperatively localize the lesion. We examined time-related changes in radiopharmaceutical uptake in parathyroid adenomas (PTAs) and thyroid gland by quantitative single-photon-emission computed tomography (SPECT) imaging to assess differences between rapid and delayed washout patterns. PATIENTS AND METHODS The study group consisted of 35 histologically verified PTAs after radio-guided surgery extirpation in 33 patients with primary hyperparathyroidism. Patients underwent a three-phase SPECT/CT study of the neck and upper thorax post 99mTc-methoxyisobutylisonitrile (MIBI) injection. Images were reconstructed using a proprietary ordered-subset-conjugate-gradient-maximization algorithm (Siemens xSPECT Quant). PTAs were divided into those with a rapid (group A) and those with a slow (group B) washout pattern. SUVmax values of PTAs and thyroid gland tissue at 10, 90 and 180 min post 99mTc-MIBI injection were recorded and statistically assessed. Retention indexes related to the early examination were calculated for PTA and thyroid gland (RI-PTA and RI-TG). RESULTS There were 11 PTAs in group A and 24 in group B. Significant between-group differences in PTA SUVmax and PTA/thyroid gland ratios were observed only at 180 min postinjection (P = 0.0297, P = 0.0222, respectively). RI-PTAs differed significantly at 90 and 180 min postinjection (P = 0.0298, P = 0.0431). No differences in PTA volumes, thyroid gland SUVmax values or RI-TG were observed between the groups. CONCLUSION PTAs with rapid and slow washout patterns have different characteristics on quantitative analysis in later phases. No significant differences in directly measurable quantitative values (SUVmax, PTA/thyroid gland ratio) at the early stages of multi-phase examination were observed.
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Affiliation(s)
| | | | | | - Martin Formanek
- Department of Otorhinolaryngology, University Hospital Ostrava and Medical Faculty, University Ostrava, Ostrava, Czech Republic
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Role of 11C-Methionine PET/CT in 99mTc-Sestamibi-Negative Parathyroid Adenoma: A Case Report. Diagnostics (Basel) 2021; 11:diagnostics11050831. [PMID: 34064482 PMCID: PMC8147981 DOI: 10.3390/diagnostics11050831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/16/2022] Open
Abstract
We report a case of 16-year-old female primary hyperparathyroidism patient who underwent cervical ultrasonography and 99mTc-sestamibi single photon emission computed tomography/computed tomography, both of which were negative for parathyroid adenoma. Subsequent 11C-methionine positron emission tomography/CT showed positive focal uptake suggesting parathyroid adenoma, which then was confirmed pathologically.
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Marzouki HZ, Abdulhaleem M, Qasim L, Aldajani A, Samargandy S, Alhozali A, Zawawi F, Merdad M. Frequency of Preoperative Localization Techniques of Parathyroid Adenoma at King Abdulaziz University Hospital, Saudi Arabia. Cureus 2021; 13:e13550. [PMID: 33791173 PMCID: PMC8001217 DOI: 10.7759/cureus.13550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Accurate preoperative radiological localization of parathyroid pathologies paves the way to enable less invasive surgical procedures. Results on the accuracy of the different diagnostic measures are conflicting. Also, little is known about the most common location of parathyroid lesions. This paper aims to determine the most common location of parathyroid adenoma and evaluate the diagnostic performance of radiological modalities such as ultrasonography, sestamibi scintigraphy/single-photon emission computerized tomography (SPECT), magnetic resonance imaging (MRI), and computed tomography (CT) scan for the preoperative localization of parathyroid pathologies. Methods This is a retrospective study. Data were collected from patients who underwent total or partial parathyroidectomy at King Abdulaziz University Hospital between January 2000 and March 2020. The parathyroid adenoma site was detected preoperatively by a radiological method and confirmed postoperatively by the histopathology report. The performance of each preoperative localizing radiological method was evaluated based on the accuracy in localizing parathyroid pathology. Results A total of 73 patients were included in the analysis, with females being the most common gender in the study at 64%. Only complete data files were included and incomplete data files were excluded. The most frequent mode of detecting parathyroid adenoma was a sestamibi/SPECT scan (62.5%) followed by a CT scan (50%), ultrasound (34.6%), and MRI (25%). The most common location of a parathyroid adenoma was the left side. Conclusion Sestamibi/SPECT is a frequent radiological method for detecting the parathyroid lesion site as compared with CT, MRI, and ultrasonography.
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Affiliation(s)
- Hani Z Marzouki
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Mawaddah Abdulhaleem
- Department of Otolaryngology Head and Neck Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Linah Qasim
- Department of Otolaryngology Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Ahmad Aldajani
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University of Jeddah, Jeddah, SAU
| | - Shaza Samargandy
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Amani Alhozali
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Faisal Zawawi
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Mazin Merdad
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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“Painful bones, renal stones, abdominal groans, and psychic moans”. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Frey S, Couëtte C, Trésallet C, Hamy A, Caillard C, Blanchard C, Menegaux F, Chereau N, Wargny M, Lussey-Lepoutre C, Drui D, Ansquer C, Mirallié E. Utility of a Second 99mTc-MIBI Scintigraphy Before Reoperation for Patients With Persistent Sporadic Primary Hyperparathyroidism: Results of a Retrospective Multicenter Study. Ann Surg Oncol 2020; 27:3831-3839. [PMID: 32246313 DOI: 10.1245/s10434-020-08428-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Persistent primary hyperparathyroidism (PHPT) occurs in 2.5% to 15% of cases after parathyroidectomy. Few studies have evaluated the best pre-reoperative imaging approaches for persistent sporadic PHPT. This retrospective multicenter study aimed to evaluate the benefit of a second pre-reoperative 99mTc-methoxy-isobutyl-isonitrile (MIBI) scintigraphy for patients with persistent PHPT who had a 99mTc-MIBI before their initial surgery. METHODS The study enrolled 50 patients with persistent sporadic PHPT who had reoperation between 2006 and 2016 in three French University Hospitals (Angers, Nantes, and La Pitié Salpêtrière-Paris). Preoperative 99mTc-MIBI scan was performed before each operation. RESULTS After the reoperation, 42 patients (84%) were cured. By the second 99mTc-MIBI, 31 patients (62%) had a removed gland identified. A new pathologic gland was identified by a second 99mTc-MIBI in 25 patients (50%), and this imaging permitted correction of an initial surgical error in six patients (12%). A second 99mTc-MIBI showed a sensitivity of 63%, a specificity of 89%, a positive predictive value (PPV) of 78%, and a negative predictive value (NPV) of 80%. A concordant second 99mTc-MIBI and ultrasonography (17 patients) showed a sensitivity of 70%, a specificity of 81%, a PPV of 70%, and an NPV of 81%. CONCLUSIONS Performing a second 99mTc-MIBI scan permitted 62% of the persistent PHPT patients to be cured, allowing identification of new pathologic glands in 50% of the cases and correction of an initial surgical error in 12% of the cases, with high specificity and PPV. These results reinforce the fact that a second 99mTc-MIBI scan should be performed at first intention before reoperation of patients with persistent PHPT, regardless of the result from the initial 99mTc-MIBI scan.
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Affiliation(s)
- Samuel Frey
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Clément Couëtte
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Christophe Trésallet
- Service de Chirurgie Viscérale et Endocrinienne, La Pitié-Salpêtrière, Paris, France
| | - Antoine Hamy
- Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Cécile Caillard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Claire Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France.,Institut du Thorax, INSERM, CNRS, UNIV Nantes, Nantes, France.,Université de Nantes, quai de Tourville, Nantes, France
| | - Fabrice Menegaux
- Service de Chirurgie Viscérale et Endocrinienne, La Pitié-Salpêtrière, Paris, France
| | - Nathalie Chereau
- Service de Chirurgie Viscérale et Endocrinienne, La Pitié-Salpêtrière, Paris, France
| | - Matthieu Wargny
- La Clinique des Données, INSERM U1413, CHU de Nantes, Nantes, France
| | | | - Delphine Drui
- Clinique d'Endocrinologie-Maladies Métaboliques et Nutrition, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | - Eric Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Centre Hospitalier Universitaire de Nantes, Nantes, France. .,Université de Nantes, quai de Tourville, Nantes, France.
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Abstract
Proliferative pathologic lesions of parathyroid glands encompass a spectrum of entities ranging from benign hyperplastic processes to malignant neoplasia. This review article outlines the pathophysiologic classification of parathyroid disorders and describes histologic, immunohistochemical, and molecular features that can be assessed to render accurate diagnoses.
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Affiliation(s)
- Julie Guilmette
- Department of Pathology, Charles-Lemoyne Hospital, Sherbrooke University Affiliated Health Care Center, 3120 Boulevard Taschereau, Greenfield Park, Quebec J4V 2H1, Canada
| | - Peter M Sadow
- Departments of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114-2696, USA.
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de Oliveira AM, Paulino MV, Vieira APF, McKinney AM, da Rocha AJ, dos Santos GT, Leite CDC, Godoy LFDS, Lucato LT. Imaging Patterns of Toxic and Metabolic Brain Disorders. Radiographics 2019; 39:1672-1695. [DOI: 10.1148/rg.2019190016] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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14
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Xia C, Zhu Q, Li Z, Hu M, Fang J, Zhong Q, Yue C, Bai Y. Study of the Ultrasound Appearance of the Normal Parathyroid Using an Intraoperative Procedure. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:321-327. [PMID: 29802631 DOI: 10.1002/jum.14691] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/28/2018] [Accepted: 04/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study was designed to confirm the echogenicity of normal parathyroid glands using intraoperative ultrasound (US). METHODS Between October 2015 and January 2016, normal parathyroid glands were examined with an intraoperative US transducer during thyroidectomy procedures in 13 patients with thyroid disease. According to the findings from intraoperative US, routine percutaneous US of normal parathyroid glands was performed in a group of adults. On the basis of previous information on normal parathyroid echogenicity, a series of parathyroid diseases that were proved by surgery and histopathologic analyses were retrospectively reviewed. The presence of residual normal parathyroid in the lesion on US imaging, which was defined as the residual parathyroid sign in this study, was reviewed and correlated with histopathologic results. RESULTS In the intraoperative US group, 23 parathyroid glands were scanned intraoperatively, and 21 (91.3%) were hyperechoic, homogeneous in texture, and oval. In the routine percutaneous US group, 106 parathyroid glands were found in total, and 96 (90.5%) of the glands had hyperechoic and homogeneous echogenicity, with 75 (70.8%) being oval. In the review of parathyroid diseases, 33 parathyroid glands in 30 cases were reviewed, with a positive residual parathyroid sign in 7 (21.2%) parathyroid glands, presenting with a hyperechoic rim in the margin, and 4 of them (12.1%) were confirmed by histopathologic results. CONCLUSIONS The normal parathyroid had hyperechoic echogenicity on both intraoperative and percutaneous US imaging. Residual tissue of parathyroid glands can also be observed in some parathyroid abnormalities with an echogenic appearance on US imaging and confirmed by histopathologic results.
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Affiliation(s)
- Chunxia Xia
- Department of Radiology, Division of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhu
- Department of Radiology, Division of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zheng Li
- Department of Diagnostic Ultrasound, Beijing Aerospace General Hospital, Beijing, China
| | - Minxia Hu
- Department of Radiology, Division of Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jugao Fang
- Department of Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi Zhong
- Department of Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Changli Yue
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuping Bai
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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LeBlanc RA, Isaac A, Abele J, Biron VL, Côté DWJ, Hearn M, O'Connell DA, Seikaly H, Harris JR. Validation of a novel method for localization of parathyroid adenomas using SPECT/CT. J Otolaryngol Head Neck Surg 2018; 47:65. [PMID: 30367667 PMCID: PMC6203983 DOI: 10.1186/s40463-018-0307-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/07/2018] [Indexed: 12/19/2022] Open
Abstract
Background Accurate localization of parathyroid adenomas is of critical importance in surgical planning for minimally invasive parathyroidectomy. SPECT/CT is considered the investigation of choice but has limitations regarding localization of superior versus inferior adenomas. We proposed a novel method for localization using SPECT/CT by determining the anterior-posterior relationship of the adenoma to a horizontal line in the coronal plane through the tracheoesophageal groove. Our objective was to determine the accuracy, validity, and inter-rater reliability of this method. Method This was a retrospective review of patients who underwent parathyroidectomy for a single adenoma between 2010-2017. SPECT/CT images were reviewed by two staff Otolaryngologists, a Radiologist, an Otolaryngology fellow and Otolaryngology resident. Results were compared using intra-operative report as the gold standard. Overall accuracy in determining superior/inferior and right/left adenomas was calculated, as well as Cohen's Kappa to determine agreement with operative report and inter-rater reliability. The performance was compared to that of the original radiology report. Results One hundred thirty patients met criteria and were included. Our method correctly identified the location of the adenoma in terms of both side and superior/inferior position in 80.4% [76 - 84%] of patients, which considerably outperformed the original radiology report at 48.5% [4-78%] accuracy. The agreement level between our method and operative report was high (Kappa=0.717 [0.691-0.743]), as was the inter-rater reliability (Kappa=0.706 [0.674-0.738]). Conclusion We report a novel method for localization of parathyroid adenomas using SPECT/CT which outperforms standard radiology reporting. This tool can be used by surgeons and radiologists to better inform and plan for minimally invasive parathyroidectomy.
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Affiliation(s)
- Rachelle A LeBlanc
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Andre Isaac
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Jonathan Abele
- Department of Radiology & Diagnostic Imaging, Royal Alexandra Hospital, 1046 Royal Alexandra Hospital - Diagnostic Treatment Center, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 Street, Edmonton, AB, T6G 2R7, Canada
| | - Vincent L Biron
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - David W J Côté
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Matthew Hearn
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Daniel A O'Connell
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Jeffrey R Harris
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, 1E4 Walter Mackenzie Center, 8440 112 Street, Edmonton, AB, T6G 2B7, Canada.
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16
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Spence RAJ, Patterson TJ, Currie P, Convie L, Tong L, Brown T, Spence RAJ. Renal failure parathyroidectomy - Is pre-operative imaging worthwhile? Surgeon 2018; 17:201-206. [PMID: 30097345 DOI: 10.1016/j.surge.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/07/2018] [Accepted: 07/10/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tertiary hyperparathyroidism is a significant issue in renal failure patients and some require surgery to control their serum calcium. A number of imaging techniques are used to localise the position of the parathyroid glands prior to surgery. Currently, a combination of ultrasound and isotope preoperative localisation imaging is accepted as useful in parathyroid surgery for primary disease. However, the use of pre-operative imaging in parathyroid surgery in renal failure patients is uncertain. The role of pre-operative imaging of the parathyroid glands in patients with renal failure hyperparathyroidism was assessed with imaging outcomes compared to operative and pathological findings in two cohorts of patients undergoing parathyroid surgery - primary and tertiary. METHODS All data were collected prospectively over a 10-year period (2003-2013) from the practice of a single surgeon. Patients were grouped into either primary hyperparathyroidism (49 patients) or tertiary hyperparathyroidism (41 patients). The majority, 63 of 90 (70%) patients, underwent both ultrasound (US) and isotope (MIBI) pre-operative imaging. Pre-operative imaging was correlated with operative and pathological findings. FINDINGS Comparison of the results of the two groups using ordinal regression analysis confirmed these imaging techniques are significantly more accurate in primary than tertiary parathyroid surgery (p = 0.022). CONCLUSIONS While accepted practice of pre-operative combined USS and MIBI imaging is essential in unilateral imaged-focused neck exploration for primary disease, these imaging techniques have a more limited use pre-operatively in renal failure parathyroidectomy.
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Affiliation(s)
- Robert A J Spence
- General Surgical Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, United Kingdom.
| | - Timothy J Patterson
- Queen's University Belfast, University Road, Belfast, BT9 1NN, Northern Ireland, United Kingdom
| | - Peter Currie
- Queen's University Belfast, University Road, Belfast, BT9 1NN, Northern Ireland, United Kingdom
| | - Liam Convie
- General Surgical Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, United Kingdom
| | - Lioe Tong
- Pathology, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, United Kingdom
| | - Tim Brown
- Renal Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, United Kingdom
| | - Roy A J Spence
- General Surgical Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, United Kingdom
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17
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Meng L, Liu S, Al-Dayyeni A, Sheng Z, Zhou Z, Wang X. Comparison of Initial Clinical Presentations between Primary Hyperparathyroidism Patients from New Brunswick and Changsha. Int J Endocrinol 2018; 2018:6282687. [PMID: 30363962 PMCID: PMC6186333 DOI: 10.1155/2018/6282687] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/27/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare the initial clinical features, laboratory values, and bone mineral density among patients with primary hyperparathyroidism (PHPT) in Changsha (China) and New Brunswick (USA). METHODS In this retrospective study, we reviewed 169 PHPT patients who presented at Robert Wood Johnson University Hospital and 133 PHPT patients who presented at the Second Xiangya Hospital of Central South University in the same time period. The following characteristics were compared between the groups: age, gender, BMI, serum calcium, alkaline phosphatase (AKP), albumin, intact PTH (iPTH), 25-hydroxyvitamin D (25 (OH) D), fasting blood glucose levels, and bone mineral density (BMD). All these parameters were also compared according to gender and menopausal status. iPTH associations were also assessed along with several other parameters. RESULTS PHPT patients from Changsha had higher serum calcium, iPTH, and AKP levels but lower 25 (OH) D levels than the patients from New Brunswick (p < 0.05). Patients in Changsha had lower T-scores and Z-scores in both the lumbar spine and hip regions than those in New Brunswick (p < 0.05). Patients in New Brunswick had lower percentages of parathyroid adenoma and kidney stones. Serum iPTH level was positively correlated with serum calcium and serum AKP levels in both Changsha and New Brunswick (p < 0.05). CONCLUSIONS There are distinct biochemical and clinical differences between patients with PHPT in China and the United States. Our study revealed that Asian PHPT patients from Changsha presented more severe PHPT profiles, lower bone mineral density, and higher incidence of renal stones.
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Affiliation(s)
- Lingqiong Meng
- Division of Endocrinology and Metabolism, Rutgers-RWJMS, New Brunswick, NJ 08901, USA
- Graduate School of Biomedical Science, Rutgers University, Piscataway, NJ 08854, USA
| | - Shuying Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Aseel Al-Dayyeni
- Division of Endocrinology and Metabolism, Rutgers-RWJMS, New Brunswick, NJ 08901, USA
- Physiology and Integrative Biology, Rutgers University, New Brunswick, NJ 08901, USA
| | - Zhifeng Sheng
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- Institution of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- Institution of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xiangbing Wang
- Division of Endocrinology and Metabolism, Rutgers-RWJMS, New Brunswick, NJ 08901, USA
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18
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Lastoria S, Marciello F, Faggiano A, Aloj L, Caracò C, Aurilio M, D'Ambrosio L, Di Gennaro F, Ramundo V, Camera L, De Luca L, Fonti R, Napolitano V, Colao A. Role of (68)Ga-DOTATATE PET/CT in patients with multiple endocrine neoplasia type 1 (MEN1). Endocrine 2016; 52:488-94. [PMID: 26242621 DOI: 10.1007/s12020-015-0702-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/20/2015] [Indexed: 11/26/2022]
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is a hereditary syndrome predisposing to many endocrine and neuroendocrine tumors (NET). Conventional imaging (CI) cannot provide satisfactory results for all the different types of MEN1-related tumors. Objective of this prospective observational study was to evaluate the role of (68)Ga-DOTATATE PET/CT in MEN1 compared to CI. Diagnostic performance of (68)Ga-DOTATATE PET/CT for the detection of NET was evaluated as well as the prognostic role of SUVmax. Eighteen patients with genetically confirmed MEN1 were evaluated by (68)Ga-DOTATATE PET/CT, endoscopic ultrasounds, multidetector-row computed tomography, magnetic resonance imaging, and hormone/markers serum measurements. Four MEN1-related tumor sites (pancreas, pituitary, parathyroids, adrenals) were considered. Sensitivity and specificity of (68)Ga-DOTATATE PET/CT for the detection of NET were calculated. There was (68)Ga-DOTATATE PET/CT uptake in 11/11 patients with pancreatic lesions, in 9/12 with pituitary adenoma, in 5/15 with parathyroid enlargements, and in 5/7 with adrenal lesions. (68)Ga-DOTATATE PET/CT showed sensitivity and specificity of 100 and 100 % in pancreas, 75 and 83 % in pituitary, 28 and 100 % in parathyroids, and 62.5 and 100 % in adrenals, respectively. Compared with CI, no significant difference in sensitivity for pancreas, pituitary, and adrenals was found, while CI had a better sensitivity for parathyroids (p = 0.002). On the ROC analysis, progression of pancreatic lesions was significantly associated to SUVmax <12.3 (p < 0.05). (68)Ga-DOTATATE PET/CT is greatly helpful in the work-up of MEN1 providing a panoramic view of MEN1-related lesions. There is also a prognostic role of (68)Ga-PET in patients with MEN1-pancreatic lesions.
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Affiliation(s)
- Secondo Lastoria
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy.
| | - Francesca Marciello
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Antongiulio Faggiano
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Aloj
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Corradina Caracò
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Michela Aurilio
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Laura D'Ambrosio
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Francesca Di Gennaro
- Division of Nuclear Medicine, Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale Tumori "Fondazione G.Pascale" - IRCCS Napoli, Naples, Italy
| | - Valeria Ramundo
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Camera
- Department of Biomorphological and Functional Sciences, "Federico II" University of Napoli, Naples, Italy
| | | | - Rosa Fonti
- Istitute of Biostructures and Bioimages (IBB), National Research Council, Naples, Italy
| | - Vincenzo Napolitano
- Department of General and Specialistic Surgery, Second University of Napoli, Caserta, Italy
| | - Annamaria Colao
- Division of Endocrinology, Department of Clinical Medicine and Surgery, "Federico II" University of Napoli, Via Sergio Pansini 5, 80131, Naples, Italy
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Braeuning U, Pfannenberg C, Gallwitz B, Teichmann R, Mueller M, Dittmann H, Reimold M, Bares R. 11C-methionine PET/CT after inconclusive 99mTc-MIBI-SPECT/CT for localisation of parathyroid adenomas in primary hyperparathyroidism. Nuklearmedizin 2014; 54:26-30. [PMID: 25427653 DOI: 10.3413/nukmed-0686-14-07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/14/2014] [Indexed: 11/20/2022]
Abstract
AIM To investigate the efficacy of PET/CT with 11C-methionine for localizing parathyroid adenomas in patients with suspected primary hyperparathyroidism and inconclusive results of cervical ultrasonography and 99mTc-MIBI-SPECT/CT. PATIENTS, METHOD Retrospective analysis of imaging data of 18 patients and correlation with clinical outcome, in particular intraoperative findings and histopathology of excised tissue. RESULTS 12 of 18 patients received surgery. In 10 patients single parathyroid adenomas were found (diameter: 5-20 mm), 2 patients presented parathyroid hyperplasia (5 excised hyperplastic glands (diameter: 2-12 mm). PET/CT correctly localized all adenomas and 1 of 5 hyperplastic glands. The sensitivity per patient was 91.7% (11 of 12), the sensitivity per lesion 73.3% (11 of 15). All lesions missed by PET/CT had a size smaller than 9 mm and a volume of less than 0.2 ml. In 6 patients no surgery was performed. Five of them had a negative or atypical PET/CT. Further follow-up indicated familial hypocalciuric hypercalcemia in 3 of them (thus, PET/CT true negative), in the remaining 2 patients no validation is available. One patient with 2 highly suggestive lesions rejected surgery so far. CONCLUSION PET/CT with 11C-methionine is a very sensitive method for the detection of parathyroid adenomas, even if they are too small to be visualized by 99mTc-MIBI-SPECT/CT.
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Affiliation(s)
| | | | | | | | | | | | | | - R Bares
- Prof. Dr. Roland Bares, Department Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Otfried-Mueller-Str. 14, 72076 Tuebingen, Germany
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20
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Bindal R, Kumar A, Singh HP, Bansal SK, Sharma A. Evidence based solving approach in diagnosis of primary hyperparathyroidism with oral manifestations: report of three unusual cases. J Lab Physicians 2014; 5:113-7. [PMID: 24701104 PMCID: PMC3968620 DOI: 10.4103/0974-2727.119863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary hyperparathyroidism is a common condition that affects 0.3% of the general population in which excessive production of PTH is there. With changing trends it is diagnosed early and asymptomatically with the improvements in routine biochemical tests and radiological procedures. The late bony complications of the disease have therefore started to decline rapidly. The mandible is the predominantly affected site in the maxillofacial area. Maxillary involvement is rare. Here, we reported series of three cases of 30-40-year-old women with osteolytic lesions and bone resorption in maxilla or mandible. Two of presented cases demonstrated evidence of lesions in both mandible and maxilla which is a very rare event. A thorough diagnostic work-up emphasizing on biochemical and radiographic investigations were discussed. We highlighted the role of endocrinologist, oral and maxillofacial surgeons, general practitioner dentists, and radiologists in diagnosing and managing such patients.
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Affiliation(s)
- Ruchi Bindal
- Department of Oral Medicine and Radiology, Yamuna Institute of Dental Sciences and Research, Yamunanagar, India
| | - Ajay Kumar
- Department of Oral and Maxillofacial Pathology and Microbiology, Yamuna Institute of Dental Sciences and Research, Yamunanagar, Punjab, India
| | - Harkanwal Preet Singh
- Department of Oral and Maxillofacial Pathology and Microbiology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
| | - Sanjiv Kumar Bansal
- Department of Biochemistry, SGT Medical College, Hospital and Research Institute, Budhera, India
| | - Aadya Sharma
- Department of Oral and Maxillofacial Surgery, SGT Dental College, Gurgaon, Haryana, India
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