Wataru Kitagawa, Kazuo Shimizu, Haruki Akasu, Shigeo Tanaka
Med Sci Monit 2003; 9(2): CS9-12
BACKGROUND: The usefulness of radioguided parathyroidectomy for primary hyperparathyroidism has been demonstrated in recent years, however, its applicability to renal hyperparathyroidism is uncertain. We report a case in which radioguided parathyroidectomy was used to treat renal hyperparathyroidism and was found to be helpful in preventing persistent and recurrent hyperparathyroidism. CASE REPORT: The patient was a 55-year-old Japanese woman who had received hemodialysis for 67 months. Three enlarged parathyroid glands were identified preoperatively by ultrasonography. Two hours before the operation, the patient received an intravenous injection of 600 MBq 99mTc-sestamibi and radioguided parathyroidectomy was performed. The three enlarged parathyroid glands were resected easily by the use of radioguided surgery. However, the localization of the residual parathyroid gland was uncertain. The operative field was analyzed using an intraoperative gamma probe, and the upper mediastinum was found to have higher radioactivity than the other regions. The upper mediastinum was dissected and the enlarged parathyroid gland was identified in the anterosuperior mediastinum in front of the trachea. The target parathyroid gland was then removed. The pathological diagnosis was hyperplasia of the parathyroid. No complications were observed and a follow-up examination 30 months later did not show any recurrence. CONCLUSIONS: An intraoperative gamma probe can be used to locate supernumerary and ectopic parathyroid glands. Radioguided parathyroidectomy for renal hyperparathyroidism can theoretically decrease the risk of persistent and recurrent hyperparathyroidism that is due to remaining parathyroid tissue.
Keywords: Hyperparathyroidism, Secondary - surgery, Kidney Diseases - complications, Parathyroid Glands - pathology, Parathyroid Glands - surgery, Parathyroid Neoplasms - pathology, Parathyroid Neoplasms - radiography, Parathyroid Neoplasms - surgery, Radiopharmaceuticals - diagnostic use, Technetium Tc 99m Sestamibi - diagnostic use