Parathyroid Imaging. A Guide to Parathyroid Surgery
|
|
- Alban Copeland
- 6 years ago
- Views:
Transcription
1 Parathyroid Imaging A Guide to Parathyroid Surgery
2 Primary Hyperparathyroidism (PHPT) 3 rd most common endocrine disorder after diabetes and hyperthyroidism Prevalence in women 2% Often discovered in asymptomatic pts because of elevation of serum calcium Dx: associated with elevated serum calcium and elevated PTH PTH may be normal but inappropriate to hypercalcemia Familial hypercalciuric hypercalcemia pts are not surgical candidates
3 Hyperparathyroidism: Symptoms Fragile bones that easily fracture (osteoporosis) Renal stones Increased frequency of urination Unexplained abdominal pain Fatigue out of proportion to task Depression Forgetfulness Bone and joint pain Frequent complaints of illness with no apparent cause GI complaints (nausea, vomiting or loss of appetite)
4 Parathyroid Hormone
5 Parathyroid Hormone (PTH) Secreted by the chief cells of the parathyroid gland as an 84 amino acid polypeptide Increases blood concentration of ionic calcium
6 Parathyroid Hormone (PTH) Acts on parathyroid hormone 1 receptor in bone and kidney Acts on parathyroid hormone 2 receptor in the CNS,pancreas, testes and placenta Half-life of 4 minutes
7
8 Regulation of PTH Secretion Controlled by serum calcium through negative feedback Calcium-sensing receptors on parathyroid cells activated when calcium is elevated Additional calcium receptors found in brain, heart, skin, stomach and other tissues. High calcium levels inhibits secretion of preformed PTH from storage granules in the parathyroid gland
9 Stimulators of PTH Secretion Decreased serum calcium Mild decreases in serum Magnesium Increase in serum phosphate Calcium phosphate complex reduces available calcium for receptors resulting in increased PTH secretion
10 Inhibitors of PTH Secretion Increased serum Calcium Severe decreases in Magnesium May produce symptoms of hypoparathyroidism Calcitriol Hormonally active metabolite of Vitamin D Increases the level of calcium in the blood by increasing GI absorption Possibly increases release of bone calcium
11 Indications for Parathyroid Surgery * Only curative treatment for PHPT Indicated in any patient < 50 with serum calcium >0.25 mmol/l(>1mg/dl) above upper limit of normal 24hr-urine calcium >10 mmol Creatinine clearance < 60ml/min * Bilezikian, JP, et al. Guidelines for the management J Clin Endocrinol Metab 99: , 2014
12 Indications for Parathyroid Surgery * Increased stone risk (evidence of stone on imaging) Osteoporosis Vertebral fracture on imaging * Bilezikian, JP, et al. Guidelines for the management J Clin Endocrinol Metab 99: , 2014
13 Rationale for Preoperative Parathyroid Imaging Planning Surgical Strategy Limited exploration vs bilateral Determination of ectopic parathyroid tissue Evaluate recurrent disease Persistent elevation of PTH as high as 20% * Not an initial diagnostic test PTH, Serum Calcium to evaluate patient s signs and symptoms * Bergenfelz, AO, et al. Results of surgery.arch Surg 396:83-90, 2011
14 Normal Parathyroid
15 Ectopic Parathyroid
16 Ectopic Parathyroid Incidence of ectopic parathyroid glands approximately 6-16% * Single parathyroid adenoma most frequent Multi-Glandular Disease (MGD) 2-3 adenomas or MGD hyperplasia in 15-20% of cases Parathyroid Carcinoma (less than 1%) * Phitayakorn, R., et al. Incidence and location of ectopic.. Am J Surg 191: , 2006
17 Ectopic Parathyroid MGD sporadic or hereditary Isolated familial PHPT MEN-1, MEN-2A, MEN-4 Parathyroid involvement MEN-1 = 95% Suspect MGD in pts with neck radiation or Lithium exposure 5 th parathyroid in 10-15% of normal subjects As many as 2% of subjects require thoracic surgery instead of cervical surgery* * Phitayakorn, R., et al. Incidence and location of ectopic.. Am J Surg 191: , 2006
18 Parathyroid Imaging Methods Ultrasound Planar imaging with parallel hole collimator Early and delayed views (3 hours) Pinhole collimator Dual isotope planar/pinhole Dual isotope with subtraction SPECT SPECT/CT
19 Parathyroid Imaging Methods Non-invasive No radiation Cost effective Operator dependent Ultrasound Sensitivity and specificity variable Comparison with MIBI difficult and dependent on techniques used MIBI superior for localizing ectopic parathyroid
20 Radiopharmaceuticals in PHPT Imaging Thallium-201 Potassium Analog Tc-99m MIBI Mitochondrial seeking agent Tc-99m Pertechnetate Thyroid gland imaging I-123 Thyroid gland imaging
21 * *
22 Parathyroid Adenoma Pertechnetate Planar MIBI Planar
23 Parathyroid Adenoma SPECT MIBI SPECT Pertechnetate SPECT
24 Parathyroid Adenoma 2.5 hours delay
25 MIBI early planar Thyroid Adenoma Thyroid Adenoma (concordant MIBI/Pertechnetate) MIBI SPECT Pertechnetate
26 Parathyroid Adenoma (Value of SPECT) MIBI planar Pertechnetate planar
27 Parathyroid Adenoma 3-hour delayed image
28 Parathyroid Adenoma Tc99m MIBI SPECT Pertechnetate SPECT
29 Parathyroid/Thyroid Adenoma Value of delayed imaging and SPECT MIBI early planar MIBI delayed planar
30 Parathyroid/Thyroid Adenoma Value of delayed imaging and SPECT MIBI SPECT Pertechnetate SPECT
31 Comparison of Tc-99m Sestamibi/Pertechnetate Planar & SPECT Imaging with Ultrasound: Advantage of Combined Studies Irina Lev, B.S Waxman, Alan D, M.D; Ih, Grace, B.S D'Agnolo, Alessandro, M.D; Thomson, Louise, M.D ; Adashek, Kenneth, M.D; Melany, Michelle, M.D Cedars Sinai Medical Center, Department of Imaging, Los Angeles, CA SNM National Meeting June 2010
32 MIBI/US FOR PARATHYROID ADENOMA : RESULTS TP FP TN FN Sens Acc PPV NM hyperplasia NM Adenoma NM Total N=127 U/S N= % 86% 100% % 96% 100% % 95% 100% % 95% 99%
33 MIBI/US FOR PARATHYROID ADENOMA : RESULTS Adenoma sensitivity = 96% with a PPV = 100% FN adenoma sizes were 8,7,6,5 mm 2 were detected with U/S Hyperplasia sensitive = 86% PPV = 100%. U/S sensitivity = 93% PPV = 99% FN adenoma U/S sizes were 8,7,7,6,5 mm 4 of these were detected with MIBI There was only 1 pt that was (-)on both U/S and MIBI
34 ECTOPIC PARATHYROID Need for identification prior to surgical exploration MIBI/SPECT-CT best single test
35 Ectopic Parathyroid : MIBI vs US Incidence and Localization of Ectopic Parathyroid Adenomas in previously Unexplored Patients. Roy M, et al. World J Surg. 37: , (2013)
36 Limited vs Bilateral National Trends in Parathyroid Surgery from 1998 to 2008: A Decade of Change. Greene AB, et al. J Am Coll Surg. Vol 209, No. 3, Sep 2009
37 Limited vs Bilateral National Trends in Parathyroid Surgery from 1998 to 2008: A Decade of Change. Greene AB, et al. J Am Coll Surg. Vol 209, No. 3, Sep 2009
38 Dual Isotope Subtraction Simultaneous co registration - Use I-123 Photo peak (159kEv) - Use Tc-99m photo peak (140kEv) Able to use planar and SPECT dual photo peak
39 EB - 64 YEAR OLD FEMALE
40 Dual Isotope Subtraction (Tc-99m I123) EB
41 EB Parathyroid Adenoma I-123 Subtraction from Tc-99m MIBI
42 77 year old female With elevated serum calcium and borderline elevation of PTH DG
43 DG
44 DG
45 DG I-123 Subtraction from Tc-99m MIBI
46 DG Parathyroid Adenoma I-123 Subtraction from Tc-99m MIBI
47 SPECT-CT High sensitivity Improved specificity Localization
48 40 YEAR OLD FEMALE WITH HYPERCALCEMIA MG/DL (NORMAL ) NECK ULTRASOUND = 1.7 cm hypoechoic nodule inferior to right thyroid lobe suspicious for an enlarged parathyroid. OH
49 OH
50 Parathyroid Adenoma EARLY 3 HOUR OH
51 OH Parathyroid Adenoma SPECT/CT
52 67 year old male with clinical suspicion of parathyroid adenoma. Serum Calcium 10.6 (H) ( mg/dl). Parathyroid Hormone 78 (H) (14-64 pg/ml) U/S = MNG LE
53 67 year old male with clinical suspicion of parathyroid adenoma. LE
54 LE
55 PS 76 yo female with parathyroidectomy 11 years ago now with rising PTH and Calcium levels Parathyroid hormone 83.3 (H) (14-72 pg/ml). Calcium 11.4 (H) ( mg/dl) Ultrasound demonstrates multi-nodular thyroid with no parathyroid adenoma located. CT negative for parathyroid adenoma
56 PS
57 Early 3hr- Delayed PS
58 Dx = TE Groove Parathyroid Adenoma Early MIBI PS
59 56 year old female Hx of total thyroidectomy and total parathyroidectomy for multinodular goiter and parathyroid hyperplasia right lower pole parathyroid was implanted in the patient's right forearm Patient has persistent elevation of parathyroid hormone. U/S negative EC
60 EC
61 EC Dx = L paratracheal PTA
62 EC Dx = L paratracheal PTA
63 EC Dx = L paratracheal PTA
64 EC Dx = L paratracheal PTA
65 EC Implanted Parathyroid Right Forearm
66 Summary Parathyroid imaging used for pre-surgical planning in pts with biochemical markers suggesting parathyroid adenoma or hyperplasia U/S mainly used as complimentary to MIBI Performs poorly in ectopic parathyroid Operator dependent MIBI/SPECT becoming standard of practice MIBI/SPECT-CT gives high sensitivity and specificity as well as location
Case 2: 30 yr-old woman with 7 yr history of recurrent kidney stones
Case 2: 30 yr-old woman with 7 yr history of recurrent kidney stones Giuliano Mariani Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa (Italy) 30 yr-old woman with 7 yr history
More informationhypercalcemia of malignancy hyperparathyroidism PHPT the most common cause of hypercalcemia in the outpatient setting the second most common cause
hyperparathyroidism A 68-year-old woman with documented osteoporosis has blood tests showing elevated serum calcium and parathyroid hormone (PTH) levels: 11.2 mg/dl (8.8 10.1 mg/dl) and 88 pg/ml (10-60),
More informationHYPERPARATHYROIDIS M FAISAL GHANI SIDDIQUI MBBS; FCPS; PGDIP-BIOMEDICAL ETHICS; MCPS-HPE
HYPERPARATHYROIDIS M FAISAL GHANI SIDDIQUI MBBS; FCPS; PGDIP-BIOMEDICAL ETHICS; MCPS-HPE PROFESSOR OF SURGERY J I N N A H S I N D H M E D I C A L U N I V E R S I T Y PREAMBLE Anatomy & physiology of the
More informationOutline. Primary Hyperparathyriodism. SPECT/CT in Parathyroid Localisation. Ann-Marie Quigley Nuclear Medicine Royal Free Hospital London
SPECT/CT in Parathyroid Localisation Ann-Marie Quigley Nuclear Medicine Royal Free Hospital London Outline Pathophysiology Current guidelines SPECT/CT the evidence SPECT/CT in clinical scenarios MGD, Nodular
More information4/20/2015. The Neck xt Exploration: Intraoperative Parathyroid Hormone (IOPTH) Testing During Surgical Parathyroidectomy. Learning Objectives
The Neck xt Exploration: Intraoperative Parathyroid Hormone (IOPTH) Testing During Surgical Parathyroidectomy Nichole Korpi-Steiner, PhD, DABCC, FACB University of North Carolina Chapel Hill, NC Learning
More informationParathyroid Imaging What is best
Parathyroid Imaging What is best Mike Avison Bradford Why me? I m honoured to be asked to present this. There is no killer paper or text which clearly proves the best methodology. Bradford has performed
More informationOutline. SPECT/CT in Parathyroid Disease. Pathophysiology. Current guidelines. SPECT/CT the evidence. SPECT/CT in clinical scenarios
SPECT/CT in Parathyroid Disease Ann-Marie Quigley Nuclear Medicine Royal Free Hospital London Outline Pathophysiology Current guidelines SPECT/CT the evidence SPECT/CT in clinical scenarios MGD, Nodular
More informationPARATHYROID NUCLEAR MEDICINE IMAGING REVIEW DISCLOSURES
PARATHYROID NUCLEAR MEDICINE IMAGING REVIEW Miguel Hernandez Pampaloni, M.D., Ph.D. Chief, Nuclear Medicine Assistant Professor of Radiology UCSF Department of Radiology and Biomedical Imaging DISCLOSURES
More informationPRIMARY HYPERPARATHYROIDISM PRIMARY HYPERPARATHYROIDISM. Hyperparathyroidism Etiology. Common Complex Insidious Chronic Global Only cure is surgery
ENDOCRINE DISORDER PRIMARY HYPERPARATHYROIDISM Roseann P. Velez, DNP, FNP Francis J. Velez, MD, FACS Common Complex Insidious Chronic Global Only cure is surgery HYPERPARATHYROIDISM PARATHRYOID GLANDS
More informationMinimally invasive parathyroidectomy
Minimally invasive parathyroidectomy Jessica E. Gosnell MD Assistant Professor of Surgery March 22, 2011 1 Minimally invasive parathyroidectomy 1. What? 2. When? 3. How? 4. Convert? 5. What adjuncts? Primary
More informationApproach to a patient with hypercalcemia
Approach to a patient with hypercalcemia Ana-Maria Chindris, MD Division of Endocrinology Mayo Clinic Florida 2013 MFMER slide-1 Background Hypercalcemia is a problem frequently encountered in clinical
More informationHyperparathyroidism. When to Suspect, How to Diagnose, When and How to Intervene. Johanna A. Pallotta, MD, FACP, FACE
Hyperparathyroidism When to Suspect, How to Diagnose, When and How to Intervene Johanna A. Pallotta, MD, FACP, FACE Potential conflicts of interest: None Johanna A. Pallotta, MD Outline Definition of hyperparathyroidism
More informationPRIMARY HYPERPARATHYROIDISM
PRIMARY HYPERPARATHYROIDISM HYPERPARATHYROIDISM Inappropriate excess secretion of Parathyroid Hormone in Primary Hyperparathyroidism Appropriate Hypersecretion in Secondary Hyperparathyroidism PTH and
More informationWomen s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases
Women s Health in General Practice Symposium 2015 Thyroid & Parathyroid Cases Bill Fleming Epworth Freemasons Hospital 1 Common Endocrine Presentations anatomical problems thyroid nodule / goitre embryological
More informationComplementary sestamibi scintigraphy and ultrasound for primary hyperparathyroidism
Nuclear Medicine and Biomedical Imaging Research Article Complementary sestamibi scintigraphy and ultrasound for primary hyperparathyroidism Yang Z 1,3 *, Li AY 2, Alexander G 3 and Chadha M 3 1 Department
More informationCase 4: 27 yr-old woman with history of kidney stones and hyperparathyroidism.
Case 4: 27 yr-old woman with history of kidney stones and hyperparathyroidism. Giuliano Mariani Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa (Italy) Hyperparathyroidism
More informationHyperparathyroidism: Operative Considerations. Financial Disclosures: None. Hyperparathyroidism. Hyperparathyroidism 11/10/2012
Hyperparathyroidism: Operative Considerations Financial Disclosures: None Steven J Wang, MD FACS Associate Professor Dept of Otolaryngology-Head and Neck Surgery University of California, San Francisco
More informationHPI joint pain/arthritis serum calcium 11.5 PTH 147pg/ml
HPI 45 yo female Increased calcium level during evaluation for joint pain/arthritis W/U showed serum calcium 11.5 and PTH 147pg/ml (Normal 11-67pg/ml) Otherwise asymptomatic PMH/PSH Arthritis Tonsillectomy
More informationPARATHYROID IMAGING. James Lee, MD Chief, Endocrine Surgery Co-Director NY Thyroid-Parathyroid Center Columbia University Medical Center
PARATHYROID IMAGING James Lee, MD Chief, Endocrine Surgery Co-Director NY Thyroid-Parathyroid Center Columbia University Medical Center NO DISCLOSURES Overview The hallmarks of the ideal test Benefits
More informationPotential conflicts of interest: None
Hyperparathyroidism When to Suspect, How to Diagnose, When and How to Intervene November 6, 2013 Johanna A. Pallotta, MD, FACP, FACE Potential conflicts of interest: None Johanna A. Pallotta, MD Outline
More informationNuclear Medicine Head and Neck Region. Bán Zsuzsanna, MD University of Pécs, Department of Nuclear Medicine
Nuclear Medicine Head and Neck Region Bán Zsuzsanna, MD University of Pécs, Department of Nuclear Medicine Thyroid scintigraphy Parathyroid scintigraphy F18-FDG PET examinations in head and neck cancer
More informationCase study Group 2 presentation
Case study Group 2 presentation Patient profile HN 3095-57 Female 60 years old Hometown : Sa Kaeo province Occupation : farmer No drug and food allergy Chief complain Left neck mass 10 years PTA that gradually
More informationThe Parathyroid Glands Secrete Parathyroid Hormone, which Regulates Calcium, Magnesium, and Phosphate Ion Levels
17.6 The Parathyroid Glands Secrete Parathyroid Hormone, which Regulates Calcium, Magnesium, and Phosphate Ion Levels Partially embedded in the posterior surface of the lateral lobes of the thyroid gland
More informationMarcin Barczynski, 1 Aleksander Konturek, 2 Alicja Hubalewska-Dydejczyk, 2. Filip Gołkowski, 1 Stanislaw Cichon, 1 Piotr Richter, 1 Wojciech Nowak
3 rd Chair and Department of General Surgery 1 and Chair and Department of Endocrinology 2 Jagiellonian University, Medical College Head: Prof. Wojciech Nowak, MD, PhD INTRAOPERATIVE BILATERAL INTERNAL
More informationParathyroid Disease Scenarios for the Practicing Clinician. Vijaya Chockalingam MD Faculty Endocrinologist Banner University Medical Center- Phoenix
Parathyroid Disease Scenarios for the Practicing Clinician Vijaya Chockalingam MD Faculty Endocrinologist Banner University Medical Center- Phoenix Clinical Scenario-1 73 year man (BK) with hypercalcemia
More informationNormal PTH Levels in Primary Hyperparathyroidism: Still the Same Disease?
Ann Surg Oncol (2011) 18:3437 3442 DOI 10.1245/s10434-011-1744-x ORIGINAL ARTICLE ENDOCRINE TUMORS Normal PTH Levels in Primary Hyperparathyroidism: Still the Same Disease? Amanda L. Amin, MD, Tracy S.
More informationWhen the level of calcium in the blood falls too low, the parathyroid glands secrete just enough PTH to restore the blood calcium level.
Hyperparathyroidism Primary hyperparathyroidism is a disorder of the parathyroid glands, also called parathyroids. Primary means this disorder originates in the parathyroids: One or more enlarged, overactive
More informationComparison Of Sestamibi Scintigraphy And Ultrasonography In Preoperative Localization Of Primary Hyperparathyroidism
ISPUB.COM The Internet Journal of Surgery Volume 16 Number 1 Comparison Of Sestamibi Scintigraphy And Ultrasonography In Preoperative Localization Of Primary S Nasiri, A Sorush, A Hashemi, F Mehrkhani,
More information42 yr old male with h/o Graves disease and prior I 131 treatment presents with hyperthyroidism and undetectable TSH. 2 hr uptake 20%, 24 hr uptake 50%
Pinhole images of the neck are acquired in multiple projections, 24hrs after the oral administration of approximately 200 µci of I123. Usually, 24hr uptake value if also calculated (normal 24 hr uptake
More informationTHE ASSOCIATION OF PRIMARY HYPERPARATHYROIDISM WITH DISORDERS OF THE THYROID GLAND AND CARPENTRY OUR EXPERIENCE
24 MEDICINSKI GLASNIK / str. 24-30 Snežana Marinković, Nenad Laketić 1 THE ASSOCIATION OF PRIMARY HYPERPARATHYROIDISM WITH DISORDERS OF THE THYROID GLAND AND CARPENTRY OUR EXPERIENCE Introduction Primary
More informationOutline. Parathyroid Localization Studies. Mira Milas MD, FACS Associate Professor of Surgery Director, The Thyroid Center
Parathyroid Localization Studies Mira Milas MD, FACS Associate Professor of Surgery Director, The Thyroid Center Outline Clinical Context of Primary Hyperparathyroidism Ultrasound, Sestamibi, and Other
More informationPrimary hyperparathyroidism (HPT) has an incidence of
Dual-Phase Tc-Sestamibi Imaging: Its Utility in Parathyroid Hyperplasia and Use of Immediate/ Delayed Image Ratios to Improve Diagnosis of Hyperparathyroidism Leonie Gordon, MD; William Burkhalter, MD;
More informationEndocrine Regulation of Calcium and Phosphate Metabolism
Endocrine Regulation of Calcium and Phosphate Metabolism Huiping Wang ( 王会平 ), PhD Department of Physiology Rm C516, Block C, Research Building, School of Medicine Tel: 88208252 Email: wanghuiping@zju.edu.cn
More informationResearch Article Primary Hyperparathyroidism: 11-Year Experience in a Single Institute in Thailand
International Endocrinology Volume 2012, Article ID 952426, 4 pages doi:10.1155/2012/952426 Research Article Primary Hyperparathyroidism: 11-Year Experience in a Single Institute in Thailand Poramaporn
More informationParathyroid Imaging: Current Concepts. Maria Gule-Monroe, M.D. Nancy Perrier, M.D.
Parathyroid Imaging: Current Concepts Maria Gule-Monroe, M.D. Nancy Perrier, M.D. Disclosures None Objectives Ultrasound characteristics of parathyroid adenomas vs. lymph nodes 4D-CT evaluation of hyperparathyroidism
More informationCKD: Bone Mineral Metabolism. Peter Birks, Nephrology Fellow
CKD: Bone Mineral Metabolism Peter Birks, Nephrology Fellow CKD - KDIGO Definition and Classification of CKD CKD: abnormalities of kidney structure/function for > 3 months with health implications 1 marker
More informationEndocrine Surgery When to Refer and What We Do
Endocrine Surgery When to Refer and What We Do None Disclosures W. Heath Giles, M.D., F.A.C.S. Surgery Residency Program Director Assistant Professor of Surgery What is Endocrine Surgery? Who performs
More informationSPECT/CT in Endocrine Diseases and Dosimetry
SPECT/CT in Endocrine Diseases and Dosimetry Heather A. Jacene, MD Division of Nuclear Medicine Russell H. Morgan Dept. of Radiology and Radiological Science Johns Hopkins University Baltimore, MD Disclosures
More informationNews on the treatment of HPT
News on the treatment of HPT G.C. Torre XIV Annual Conference of EES Tourin 25-27 November 2010 Epidemiology Prevalence: Sweeden = 4.3 /1000 Norway = 3/1000 Finland = 21/1000 USA = 1/1000 Italy = 5/1000
More informationSouthern Derbyshire Shared Care Pathology Guidelines. Primary Hyperparathyroidism
Southern Derbyshire Shared Care Pathology Guidelines Primary Hyperparathyroidism Please use this Guideline in Conjunction with the Hypercalcaemia Guideline Definition Driven by hyperfunction of one or
More informationParathyroids, Small but Mighty Current Pathways to Early Diagnosis and Cure of Parathyroid Disease
Parathyroids, Small but Mighty Current Pathways to Early Diagnosis and Cure of Parathyroid Disease Mira Milas MD, FACS Professor of Surgery Director of Endocrine Surgery No conflicts of interest or financial
More informationTHE PARATHYROID GLAND THEORY AND NUCLEAR MEDICINE PRACTICE
THE PARATHYROID GLAND THEORY AND NUCLEAR MEDICINE PRACTICE George N. Sfakianakis MD Professor of Radiology and Pediatrics Director, Division of Nuclear Medicine UM/JMMC Miami FL October 2009 ENDONCRINE
More informationEndocrine system pathology
Endocrine system pathology Central endocrine system peripheral endocrine system: thyroid gland parathyroid gland pancreas adrenal glands Thyroid gland. the weight of normal thyroid gland is about 15 grams.
More informationUltrasound Evaluation of Hyperparathyroidism
Ultrasound Evaluation of Hyperparathyroidism OBJECTIVES: 1. Why use US for localization? Advanced US course, Orlando, Florida September, 2018 2. Review the US findings and features of parathyroid adenomas
More informationThe parathyroid glands participate in the regulation
41 HERNAN I. VARGAS STANLEY R. KLEIN The parathyroid glands participate in the regulation of calcium metabolism. Disorders of the parathyroid gland are most commonly a result of hyperfunction and rarely
More informationWhat is the right calcium balance?
For patients with hypoparathyroidism What is the right calcium balance? Indications and Usage1 NATPARA is a parathyroid hormone indicated as an adjunct to calcium and vitamin D to control hypocalcemia
More informationHealth Sciences Centre, Team A, Dr. L. Bohacek (Endocrine Surgery) Medical Expert
Health Sciences Centre, Team A, Dr. L. Bohacek (Endocrine Surgery) Introduction Medical Expert This is a three month PGY 1-5 rotation in which residents gain exposure in the care and management of patients
More information25/10/56. Hypothyroidism Myxedema in adults Cretinism congenital deficiency of thyroid hormone Hashimoto thyroiditis. Simple goiter (nontoxic goiter)
THERAPEUTIC USES OF THYROID HORMONE Supeecha Wittayalertpunya Wannarasmi Ketchart Nov 2013 Hyperthyroidism (Thyrotoxicosis) Grave s disease (diffuse toxic goiter) Toxic uninodular & Toxic multinodular
More informationPRIMARY HYPERPARATHYROIDISM WITH RICKETS. KRITHIKA.P Dr.L.N.Padmasani Unit 1 Sri Ramachandra Medical College
PRIMARY HYPERPARATHYROIDISM WITH RICKETS KRITHIKA.P Dr.L.N.Padmasani Unit 1 Sri Ramachandra Medical College Presenting Complaints v 17 year old developmentally normal adolescent boy, first of a twin pregnancy,
More informationPTH > 60pg/ml PRIMARY HYPERPARATHYROIDISM. Introduction Biochemical Diagnosis. Normal Parathyroid. Parathyroid Glands
next speaker: Declan Neeson Belfast/UK SPECT/CT scanning and parathyroid surgery in Southern Trust, N. Ireland D Neeson M Korda, G Gray, C Leonard, M Fawzy, R Lambon Parathyroid Glands PRIMARY HYPERPARATHYROIDISM
More informationEndocrine University 2016 AACE-ACE-MAYO CLINIC
Endocrine University 2016 AACE-ACE-MAYO CLINIC Dev Abraham MD, MRCP (UK), ECNU Professor of Medicine (clinical), Division of Endocrinology Adjunct Professor of Surgery and Pathology Medical Director, Utah
More informationClinical Approach to Hypercalcemia For the Primary Care Provider
Clinical Approach to Hypercalcemia For the Primary Care Provider Christina Maser, MD FACS UCSF Fresno Department of Surgery, Endocrine Surgery 2/2/19 Objectives Recognition of pitfalls of diagnosis of
More informationIndex. radiologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ACC. See Adrenal cortical carcinoma. Acromegaly and the pituitary gland, 551 Acute suppurative thyroiditis, 405, 406 Addison, Thomas and
More information2016 Arizona AACE Meeting: Updated Guidelines for the Management of Primary Hyperparathyroidism (PHPT)
2016 Arizona AACE Meeting: Updated Guidelines for the Management of Primary Hyperparathyroidism (PHPT) Scott M. Wilhelm, MD, FACS Associate Professor and Section Head Endocrine Surgery University Hospitals-Cleveland
More informationHypercalcemia. Hypercalcemia: When to Worry, When to Treat! Mineral Metabolism : A Short Course
Hypercalcemia: When to Worry, When to Treat! Michael A. Levine has no financial relationships to disclose or Conflicts of Interest to resolve. Michael A. Levine, M.D. This presentation will not involve
More informationCases in Endocrinology
Bones, Moans and Groans Diagnosing and Treating Primary Hyperparathyroidism By M. Usman Chaudhry, MD Table 1 Laboratory parameters Her bone density had osteopenic T-Scores of -2.3 at lumbar spine, and
More informationNuclear medicine in endocrinology
Nuclear medicine in endocrinology Thyroid gland: anatomy, function, inflammation, Nuclear medicine in endocrinology tumor dignitiy Parathyroid gland: localisation Adrenal cortex: function Adrenal medulla:
More informationHypercalcemia & Parathyroid Disorders. W. Reid Litchfield, MD, FACE, ECNU Desert Endocrinology
Hypercalcemia & Parathyroid Disorders W. Reid Litchfield, MD, FACE, ECNU Desert Endocrinology Objectives Review diagnostic workup for hypercalcemia Review management of primary hyperparathyroidism Review
More informationUSEFULNESS OF INTRAOPERATIVE PARATHYROID HORMONE MONITORING DURING MINIMALLY INVASIVE VIDEO-ASSISTED PARATHYROIDECTOMY
USEFULNESS OF INTRAOPERATIVE PARATHYROID HORMONE MONITORING DURING MINIMALLY INVASIVE VIDEO-ASSISTED PARATHYROIDECTOMY Elisabetta Stenner elisabetta.stenner@asuits.sanita.fvg.it Introduction: primary hyperparathyroidism
More informationPersistent post transplant hyperparathyroidism. Shiva Seyrafian IUMS-97/10/18-8/1/2019
Persistent post transplant hyperparathyroidism Shiva Seyrafian IUMS-97/10/18-8/1/2019 normal weight =18-160 mg In HPT= 500-1000 mg 2 Epidemiology Mild 2 nd hyperparathyroidism (HPT) resolve after renal
More informationCoexistence of parathyroid adenoma and papillary thyroid carcinoma. Yong Sang Lee, Kee-Hyun Nam, Woong Youn Chung, Hang-Seok Chang, Cheong Soo Park
J Korean Surg Soc 2011;81:316-320 http://dx.doi.org/10.4174/jkss.2011.81.5.316 ORIGINAL ARTICLE JKSS Journal of the Korean Surgical Society pissn 2233-7903 ㆍ eissn 2093-0488 Coexistence of parathyroid
More informationCalcium metabolism and the Parathyroid Glands. Calcium, osteoclasts and osteoblasts-essential to understand the function of parathyroid glands
Calcium metabolism and the Parathyroid Glands Calcium, osteoclasts and osteoblasts-essential to understand the function of parathyroid glands Calcium is an essential element for contraction of voluntary/smooth
More informationDiagnosis and Treatment of Primary Hyperparathyroidism. Geoffrey B. Thompson, MD Professor of Surgery College of Medicine, Mayo Clinic
Diagnosis and Treatment of Primary Hyperparathyroidism Geoffrey B. Thompson, MD Professor of Surgery College of Medicine, Mayo Clinic Disclosure Nothing to Disclose Primary HPT Autonomous secretion of
More informationTargeted Issues in Endocrinology Joshua S. Coren, DO, MBA, FACOFP
Targeted Issues in Endocrinology Joshua S. Coren, DO, MBA, FACOFP Endocrine in 25 Minutes Joshua S. Coren, D.O., MBA, FACOFP Vice Chair and Associate Professor, Family Medicine Rowan University School
More informationPrimary Hyperparathyroidism
Primary Hyperparathyroidism Copyright Copyright 2019 2019 American American Associa7on Associa7on of Clinical of Clinical Endocrinologists Endocrinologists 1 Primary Hyperparathyroidism In primary hyperparathyroidism
More informationDefinition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff.
Hypercalcaemia Definition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff. Mild (usually no symptoms) 2.6 3.0 mmol/l Moderate (start to develop symptoms) 3.0 3.4
More informationThe Parathyroid Glands
The Parathyroid Glands Bởi: OpenStaxCollege The parathyroid glands are tiny, round structures usually found embedded in the posterior surface of the thyroid gland ([link]). A thick connective tissue capsule
More informationB. Environmental Factors. a. The major risk factor to papillary thyroid cancer is exposure to ionizing radiation, during the first 2 decades of life.
B. Environmental Factors. a. The major risk factor to papillary thyroid cancer is exposure to ionizing radiation, during the first 2 decades of life. b. Deficiency of dietary iodine: - Is linked with a
More informationClinical study of Multi-nodular goiter in TN medical college, Mumbai
Original article: Clinical study of Multi-nodular goiter in TN medical college, Mumbai 1Dr Rajesh Patil, 2 Dr Shalika Aeron Jayaswal, 3 Dr Snehal Kawale, 4 Dr Shazia S Malik 1,4Assistant Professor, 2 Associate
More informationDo We Do Too Many Parathyroidectomies in Dialysis? Sagar Nigwekar MD, MMSc Massachusetts General Hospital
Do We Do Too Many Parathyroidectomies in Dialysis? Sagar Nigwekar MD, MMSc Massachusetts General Hospital E-mail: snigwekar@mgh.harvard.edu March 13, 2017 Disclosures statement: Consultant: Allena, Becker
More information301 S. Westfield Rd., Suite 250 Madison, WI See inside for information about our Endocrine Surgery Referral Program
301 S. Westfield Rd., Suite 250 Madison, WI 53717 See inside for information about our Endocrine Surgery Referral Program December 2017 Dear Colleague, Thank you for referring your patient(s) to UW Health
More informationDefinition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff.
Authoriser: Fiona Davidson Page 1 of 5 Hypercalcaemia Definition Elevated Adjusted Calcium > 2.6 mmol/l (adjusted for albumin), taken without using a cuff. Mild (usually no symptoms) 2.6 3.0 mmol/l Moderate
More informationThe mystery of the hidden parathyroid adenoma. Case #1. Imaging. Case of missed adenoma. Ultrasound false nega9ves. Case of missed adenoma 5/16/16
The mystery of the hidden parathyroid adenoma AACE Annual Mee+ng 2016 Orlando, FL Case #1 Moderator: Panel: Jennifer L Mar+ MD FACS Endocrine Surgery NYC Azeez Farooki MD Endocrinology MSKCC Peter Sadow
More informationImaging in Pediatric Thyroid disorders: US and Radionuclide imaging. Deepa R Biyyam, MD Attending Pediatric Radiologist
Imaging in Pediatric Thyroid disorders: US and Radionuclide imaging Deepa R Biyyam, MD Attending Pediatric Radiologist Imaging in Pediatric Thyroid disorders: Imaging modalities Outline ACR-SNM-SPR guidelines
More informationHybrid Imaging SPECT/CT PET/CT PET/MRI. SNMMI Southwest Chapter Aaron C. Jessop, MD
Hybrid Imaging SPECT/CT PET/CT PET/MRI SNMMI Southwest Chapter 2014 Aaron C. Jessop, MD Assistant Professor, Department of Nuclear Medicine UT MD Anderson Cancer Center, Houston, Texas Complimentary role
More informationHead and Neck Endocrine Surgery
Objectives Endocrine Physiology Risk factors for hypocalcemia Management strategies Passive vs. active Treatment of hypocalcemia Department of Head and Neck Management of Calcium in Thyroid and Parathyroid
More informationPrimary hyperparathyroidism is usually a clinical and
Journal of Nuclear Medicine, published on November 7, 2008 as doi:10.2967/jnumed.108.054858 Preoperative 123 I/ 99m Tc-Sestamibi Subtraction SPECT and SPECT/CT in Primary Hyperparathyroidism Donald R.
More informationRADIOGUIDED PARATHYROIDECTOMY IS SUCCESSFUL IN 98.7% OF SELECTED PATIENTS
Original Article RADIOGUIDED PARATHYROIDECTOMY IS SUCCESSFUL IN 98.7% OF SELECTED PATIENTS Charles D. Livingston, MD, FACS ABSTRACT Objective: To examine an individualized approach to patients with primary
More informationPrimary Hyperparathyroidism
November 2002 Primary Hyperparathyroidism Lori Coburn, Harvard Medical School Year III Hyperparathyroidism An increase in parathyroid hormone (PTH) production Divided into Primary, Secondary and Tertiary
More informationHypercalcemia. Brian Rose, M.D. Bozeman Health June 6, 2018
Hypercalcemia Brian Rose, M.D. Bozeman Health June 6, 2018 Hypercalcemia Diagnosis PTH Mediated Primary Hyperparathyroidism Lithium Familial Hypocalciuric Hypercalcemia Non PTH mediated Malignancy Humoral
More informationSandostatin LAR for functional neuroendocrine tumor in MEN 1
ase Report 1 Sandostatin LR for functional neuroendocrine tumor in MEN 1 uthors: ho-lun Tsai, 1 M.., Tsu-Yao heng, 2,3 M.., Hsiu-Po Wang, 3 M.. ffiliation: 1. epartment of Internal Medicine, itmanson Medical
More informationDavid Bruyette, DVM, DACVIM
VCAwestlaspecialty.com David Bruyette, DVM, DACVIM Disorders of calcium metabolism are common endocrine disorders in both dogs and cats. In this article we present a logical diagnostic approach to patients
More informationSecondary Hyperparathyroidism: Where are we now?
Secondary Hyperparathyroidism: Where are we now? Dylan M. Barth, Pharm.D. PGY-1 Pharmacy Resident Mayo Clinic 2017 MFMER slide-1 Objectives Identify risk factors for the development of complications caused
More information"Asymptomatic" Hyperparathyroidism: Reasons for Parathyroidectomy
"Asymptomatic" Hyperparathyroidism: Reasons for Parathyroidectomy Rebecca S. Sippel, M.D. Assistant Professor Department of Surgery Section of Endocrine Surgery University of Wisconsin Primary Hyperparathyroidism
More informationThyroid nodules. Most thyroid nodules are benign
Thyroid nodules Postgraduate Course in General Surgery Jessica E. Gosnell MD Assistant Professor March 22, 2011 Most thyroid nodules are benign thyroid nodules occur in 77% of the world s population palpable
More information76 year-old female presents with muscle cramps. Jess Hwang 12/6/12
76 year-old female presents with muscle cramps Jess Hwang 12/6/12 HPI Worked up for outpatient hypercalcemia Calcium had been 10.3-11.1, PTH ~120 No h/o osteoporosis, CKD, kidney stones Not taking calcium
More informationParathyroid Glands: location, condition and value of imaging tests.
Parathyroid Glands: location, condition and value of imaging tests. Poster No.: C-2283 Congress: ECR 2015 Type: Educational Exhibit Authors: E. Elías Cabot, P. Segui, G. D. Tobar Murgueitio; Cordoba/ES
More information80 year old female with parathyroid mass and refractory hypercalcemia. Endorama September 24 th, 2015 Rajesh Jain
80 year old female with parathyroid mass and refractory hypercalcemia Endorama September 24 th, 2015 Rajesh Jain HPI 80 F with pulmonary hypertension, rheumatic mitral stenosis, atrial fibrillation on
More informationHyperparathyroidism, whether primary or secondary, is
The Value of 99m Tc-Sestamibi SPECT/CT over Conventional SPECT in the Evaluation of Parathyroid Adenomas or Hyperplasia Isis W. Gayed, MD 1 ; E. Edmund Kim, MD 1 ; William F. Broussard, BS 1 ; Douglass
More informationThyroid nodules 3/22/2011. Most thyroid nodules are benign. Thyroid nodules: differential diagnosis
Most thyroid nodules are benign Thyroid nodules Postgraduate Course in General Surgery thyroid nodules occur in 77% of the world s population palpable thyroid nodules occur in about 5% of women and 1%
More informationNatpara (parathyroid hormone) Prior Authorization with Quantity Limit Program Summary
Natpara (parathyroid hormone) Prior Authorization with Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 1 Agent Indication Dosing and Administration Natpara (parathyroid hormone) subcutaneous
More informationBone and Renal Stone Disease in Patients Operated for Primary Hyperparathyroidism in Pakistan: Is the Pattern of Disease different from the West?
ecommons@aku Section of Urology Department of Surgery August 1999 Bone and Renal Stone Disease in Patients Operated for Primary Hyperparathyroidism in Pakistan: Is the Pattern of Disease different from
More informationParathyroidectomy. Surgery for Parathyroid Problems
Parathyroidectomy Surgery for Parathyroid Problems Why You Need Parathyroid Surgery Has your doctor just recommended that you have parathyroid surgery? If so, you likely have many questions. What are the
More informationThyroid and Parathyroid Disease. RTC Conference Christina Edwards Bailey Faculty: Dr. Carmen Solorzano April 2, 2010
Thyroid and Parathyroid Disease RTC Conference Christina Edwards Bailey Faculty: Dr. Carmen Solorzano April 2, 2010 Case Presentation # 1 CC: Neck Mass HPI: 51f found to have a neck mass on routine PE.
More informationCase Report A Reference Finding Rarely Seen in Primary Hyperparathyroidism: Brown Tumor
Case Reports in Medicine Volume 2012, Article ID 432676, 4 pages doi:10.1155/2012/432676 Case Report A Reference Finding Rarely Seen in Primary Hyperparathyroidism: Brown Tumor F. Mantar, 1 S. Gunduz,
More informationNatpara (parathyroid hormone) Prior Authorization with Quantity Limit Program Summary
Natpara (parathyroid hormone) Prior Authorization with Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 2 Available Product Indication Dosing and Administration Natpara (parathyroid hormone)
More informationCurrent Concepts in the Evaluation and Management of Abnormal Parathyroid Hormone (PTH) Levels Shireen Fatemi, M.D. April, 2012.
Current Concepts in the Evaluation and Management of Abnormal Parathyroid Hormone (PTH) Levels Shireen Fatemi, M.D. April, 2012 Disclosures I have no financial relationships with commercial interests,
More informationNEOPLASMS OF THE THYROID PATHOLOGY OF PARATHYROID GLANDS. BY: Shifaa Qa qa
NEOPLASMS OF THE THYROID PATHOLOGY OF PARATHYROID GLANDS BY: Shifaa Qa qa Neoplasmas of the thyroid thyroid nodules Neoplastic ---- benign, malignant Non neoplastic Solitary nodules ----- neoplastic Nodules
More information73 year-old Female with Hypercalcemia
73 year-old Female with Hypercalcemia Katie O Sullivan, M.D. Fellow, Adult/Pediatric Endocrinology University of Chicago Thursday, December 19 th, 2013 Chief Complaint 73 year-old female who presents for
More informationSPECT/CT Fusion in the Diagnosis of Hyperparathyroidism
SPECT/CT Fusion in the Diagnosis of Hyperparathyroidism Yoshio Monzen, Akihisa Tamura, Hajime Okazaki, Taichi Kurose, Masayuki Kobayashi, Masatsugu Kuraoka Department of Radiology, Hiroshima Prefectural
More information