title: Tc99m-sestamibi scintigraphy and cell proliferation in primary hyperparathyroidism: a causal or casual relationship?
abstract: BACKGROUND
  Sestamibi scintigraphy has become the fundamental technique for preoperative location of hyperfunctioning glands responsible for hyperparathyroidism, especially in the case of adenomas. However, little is known about the mechanisms of tracer uptake and retention by these glands, mechanisms that have been related to an increased gland metabolism. Our goal was to determine whether there is a relationship between the positive result of gammagraphy with sestamibi, for diagnosing the location of parathyroid adenomas, and the cell proliferation index.
  
  
  METHODS
  Six glands corresponding to sestamibi false negatives and 12 true positives were studied in patients with single-adenoma primary hyperparathyroidism. The following data were recorded in all the patients: age, gender, clinical and analytical data, gland weight, and parathyroid hormone (PTH)/gland weight ratio. An immunohistochemical study of the glands was also done with the use of Ki67, with determination of the mean proliferation index of each group for comparison purposes.
  
  
  RESULTS
  On comparing the 2 groups, we found no differences between the clinical or analytical parameters. Differences were found only for proliferation index-(5.7% in true positive glands versus 0.3% in false negative glands (P <.004).
  
  
  CONCLUSIONS
  Tracer (sestamibi) uptake by hyperfunctioning parathyroid adenomas in primary hyperparathyroidism might be linked to a higher gland metabolism activity, probably related to cell proliferation.
authors.affiliation: Department of General Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Piñero
authors.forename: Jose M
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: Enrique
authors.initials: E
authors.lastname: Martínez-Barba
authors.forename: Manual
authors.initials: M
authors.lastname: Canteras
authors.forename: Antonia
authors.initials: A
authors.lastname: Stiges-Serra
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000236:Adenoma / Q000737:chemistry / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D002455:Cell Division; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000737:chemistry / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
chemical_list: D019394:Ki-67 Antigen; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi