title: [A case of secondary hyperparathyroidism with an ectopic intrathyroid gland successfully diagnosed and controlled by percutaneous ethanol injection therapy (PEIT)].
abstract: Secondary hyperparathyroidism (II HPT) is a major complication in chronic dialysis patients, and percutaneous ethanol injection therapy (PEIT) has become a useful alternative treatment for II HPT. However, the existence of ectopic parathyroid glands is a major problem when conducting PEIT. Ectopic parathyroid gland accepts 10-35% of II HPT, and the missing glands cannot be detected consistently by any imaging techniques, including scintigraphy. Intrathyroid parathyroid gland is as rare as about 1% and recurrence of missing glands after parathyroidectomy (PTx) has been reported in some cases. We report here a 52-year-old female in whom an ectopic parathyroid gland was defected successfully and intact-PTH controlled by tentative PEIT. At the first examination, a left parathyroid adenoma and a right thyroid goiter were pointed out by ultrasonography, CT and scintigraphy. PEIT was applied twice to the left parathyroid adenoma, but intact-PTH was not decreased. Ultrasonography, CT, 201Tl-99mTc subtraction scintigraphy and fine needle aspiration biopsy (FNAB) were performed again to search for the existence of ectopic glands. The results suggested that the right intrathyroid tumor was an ectopic parathyroid gland. Consequently, tentative PEIT was applied to the right intrathyroid tumor, and successful control of intact-PTH and serum Ca was eventually achieved. To our knowledge, this is the first reported case of secondary hyperparathyroidism with an ectopic intrathyroid gland that was successfully controlled by PEIT. In this case, it was suggested that tentative PEIT of intrathyroid tumor was a useful method for detecting an ectopic parathyroid gland.
authors.affiliation: NTT Nishinippon Kyushu General Hospital, Japan.
authors.forename: Motoko
authors.initials: M
authors.lastname: Tanaka
authors.forename: Kazuko
authors.initials: K
authors.lastname: Itoh
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Matsushita
authors.forename: Aiichirou
authors.initials: A
authors.lastname: Ogawa
authors.forename: Hideo
authors.initials: H
authors.lastname: Hirayama
authors.forename: Naoko
authors.initials: N
authors.lastname: Tsunoda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshizumi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Naruse
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonoguchi
authors.forename: Kimio
authors.initials: K
authors.lastname: Tomita
mesh_terms: D000236:Adenoma / Q000175:diagnosis*; D002828:Choristoma / Q000175:diagnosis*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy*; D015552:Injections, Intralesional; D007676:Kidney Failure, Chronic / Q000628:therapy; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000175:diagnosis*; D006435:Renal Dialysis; D013959:Thyroid Diseases / Q000175:diagnosis*
chemical_list: D000431:Ethanol