Ann Surg Treat Res.  2016 Dec;91(6):323-326. 10.4174/astr.2016.91.6.323.

Multiple endocrine neoplasia type 1 with anterior mediastinal parathyroid adenoma: successful localization using Tc-99m sestamibi SPECT/CT

• Park HL
• Yoo IR
• Kim SH
• Lee S

• KMID: 2360393
• DOI: http://doi.org/10.4174/astr.2016.91.6.323

Abstract

The most common manifestation of multiple endocrine neoplasia type 1 (MEN1) is hyperparathyroidism. Treatment of hyperparathyroidism in MEN patients is surgical removal of the parathyroid glands, however ectopic parathyroid gland is challenging for treatment. A 51-year-old female, the eldest of 3 MEN1 sisters, had hyperparathyroidism with ectopic parathyroid adenoma in the mediastinal para-aortic region, which was detected by technetium-99m (Tc-99m) sestamibi scintigraphy and single-photon emission computed tomography/computed tomography (SPECT/CT). She underwent total parathyroidectomy with video-assisted thoracoscopic surgery on an anterior mediastinal mass. Anterior mediastinal parathyroid adenoma in MEN1 patients is rare. Precise localization of an ectopic parathyroid gland with Tc-99m sestamibi SPECT/CT can lead to successful treatment of hyperparathyroidism. This is the first reported case in the literature of mediastinal parathyroid adenoma in MEN1 patient visualized by Tc-99m sestamibi SPECT/CT.

Keyword

Multiple endocrine neoplasia type 1; Parathyroid neoplasms; Single-photon emission-computed tomography; Technetium-99m sestamibi

MeSH Terms

Female
Humans
Hyperparathyroidism
Male
Middle Aged
Multiple Endocrine Neoplasia Type 1*
Multiple Endocrine Neoplasia*
Parathyroid Glands
Parathyroid Neoplasms*
Parathyroidectomy
Radionuclide Imaging
Siblings
Thoracic Surgery, Video-Assisted
Tomography, Emission-Computed, Single-Photon

Reference

1. Kivlen MH, Bartlett DL, Libutti SK, Skarulis MC, Marx SJ, Simonds WF, et al. Reoperation for hyperparathyroidism in multiple endocrine neoplasia type 1. Surgery. 2001; 130:991–998.

2. Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med. 2007; 48:1084–1089.

3. Thakker RV. Multiple endocrine neoplasia type 1 (MEN1). Best Pract Res Clin Endocrinol Metab. 2010; 24:355–370.

4. Thakker RV. Multiple endocrine neoplasia: syndromes of the twentieth century. J Clin Endocrinol Metab. 1998; 83:2617–2620.

5. Benson L, Ljunghall S, Akerstrom G, Oberg K. Hyperparathyroidism presenting as the first lesion in multiple endocrine neoplasia type 1. Am J Med. 1987; 82:731–737.

6. Burgess JR, David R, Greenaway TM, Parameswaran V, Shepherd JJ. Osteoporosis in multiple endocrine neoplasia type 1: severity, clinical significance, relationship to primary hyperparathyroidism, and response to parathyroidectomy. Arch Surg. 1999; 134:1119–1123.

7. Tonelli F, Marcucci T, Fratini G, Tommasi MS, Falchetti A, Brandi ML. Is total parathyroidectomy the treatment of choice for hyperparathyroidism in multiple endocrine neoplasia type 1? Ann Surg. 2007; 246:1075–1082.

8. Eslamy HK, Ziessman HA. Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics. 2008; 28:1461–1476.

9. Flint PW, Haughey BH, Lund VJ, Niparko JK, Robbins KT, Thomas JR, et al. Cummings otolaryngology: head and neck surgery. 6th ed.Philadelphia (PA): Elsevier/Saunders;2015.

10. Arnalsteen LC, Alesina PF, Quiereux JL, Farrel SG, Patton FN, Carnaille BM, et al. Long-term results of less than total parathyroidectomy for hyperparathyroidism in multiple endocrine neoplasia type 1. Surgery. 2002; 132:1119–1124.