title: [Ectopic parathyroid adenoma: Scintigraphic detection and radioguided surgery].
abstract: OBJECTIVE
  The aim of this study was to evaluate the role of (99m)Tc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas.
  
  
  METHODS
  We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function.
  
  
  RESULTS
  Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up.
  
  
  CONCLUSIONS
  Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up.
authors.affiliation: Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España. leticia.tardin@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: Tardin
authors.forename: E
authors.initials: E
authors.lastname: Prats
authors.forename: A
authors.initials: A
authors.lastname: Andrés
authors.forename: P
authors.initials: P
authors.lastname: Razola
authors.forename: J
authors.initials: J
authors.lastname: Deus
authors.forename: R
authors.initials: R
authors.lastname: Gastaminza
authors.forename: A
authors.initials: A
authors.lastname: Santapau
authors.forename: A
authors.initials: A
authors.lastname: Parra
authors.forename: J
authors.initials: J
authors.lastname: Banzo
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000359:Aftercare; D002828:Choristoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000652:urine; D007430:Intraoperative Care; D007677:Kidney Function Tests; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D015641:Radiography, Interventional; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi