title: Thallium-technetium subtraction scintigraphy of enlarged parathyroid glands after calcitonin stimulation of parathyroid hormone secretion.
abstract: To improve the sensitivity of thallium-technetium subtraction scintigraphy for preoperative localization procedure of enlarged parathyroid glands in primary hyperparathyroidism, we administered calcitonin intramuscularly 4 hours before the scintigraphy in 14 consecutive patients. Injection of calcitonin reduced plasma levels of ionized calcium from 1.47 +/- 0.10 mmol/l to 1.41 +/- 0.09 mmol/l (p less than 0.01). Concomitantly, serum levels of intact parathyroid hormone increased from 6.4 +/- 2.5 pmol/l to 7.9 +/- 2.6 pmol/l (p less than 0.001). The scintigram after calcitonin injection visualized 11 adenomas (sensitivity 78%) compared to only 9 (sensitivity 64%) in conventional scintigrams. In addition, 5 of the adenomas were more distinctly imaged in the scintigram after calcitonin injection, whereas in only one patient was the conventional scintigram better. Thus, the calcitonin injection improved the scintigram in 7 cases and was inferior in only one case (p = 0.031). We conclude that stimulation of parathyroid hormone secretion with calcitonin results in a better preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism.
authors.affiliation: Department of Surgery, University Hospital, Lund, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Bergenfelz
authors.forename: J
authors.initials: J
authors.lastname: Tennvall
authors.forename: B
authors.initials: B
authors.lastname: Ahrén
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging*; D000368:Aged; D002116:Calcitonin / Q000494:pharmacology; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D013670:Sodium Pertechnetate Tc 99m; D013382:Subtraction Technique; D013794:Thallium Radioisotopes / Q000378:metabolism
chemical_list: D010281:Parathyroid Hormone; D013794:Thallium Radioisotopes; D002116:Calcitonin; D013670:Sodium Pertechnetate Tc 99m