RESUMEN
Thallium-201/technetium-99m pertechnetate subtraction scintigraphy of the parathyroid glands was performed in a prospective study of 33 patients who had undergone bilateral neck exploration for elevated serum calcium and serum parathyroid hormone levels. In 31 cases, the Tl-201/Tc-99m subtraction technique yielded an overall sensitivity of 81%, specificity of 99%, and accuracy of 94% for identifying solitary parathyroid adenomas. Tl-201/Tc-99m subtraction scintigraphy correctly identified 73% of parathyroid adenomas weighing less than 499 mg, 79% of those weighing 500-1,499 mg, and 100% of adenomas weighing more than 1,500 mg. In a subgroup of 24 patients with solitary parathyroid adenomas who underwent both scintigraphy and high-resolution sonography, the sensitivity, specificity, and accuracy of both procedures were similar.
Asunto(s)
Adenoma/diagnóstico , Neoplasias de las Paratiroides/diagnóstico , Radioisótopos , Pertecnetato de Sodio Tc 99m , Talio , Ultrasonografía , Adenoma/diagnóstico por imagen , Humanos , Neoplasias de las Paratiroides/diagnóstico por imagen , Cintigrafía , Técnica de SustracciónRESUMEN
The increasing use of automated blood chemistry screens for serum calcium levels along with improved methods in measuring parathyroid hormone (PTH) levels have made the diagnosis of parathyroid disease a common clinical problem. Parathyroid adenomas account for the majority of primary hyperparathyroidism with diffuse hyperplasia and parathyroid carcinoma occurring less frequently. Early scintigraphic techniques to identify enlarged parathyroids used selenomethionine-75 which was considered to be incorporated into PTH. In general, the sensitivity of scanning the neck using this tracer was related to the size of the enlarged parathyroid, but in large series, the overall sensitivity was less than 50%. Recent work by Ferlin et al, using a Technetium-99m/Thallium-201 subtraction scintigraphic technique has yielded a sensitivity of 92% in identifying pathologically enlarged parathyroid glands. Winzelberg et al modified this technique to allow imaging the mediastinum plus simplifying the subtraction method. In a prospective study with high-resolution sonography, similar sensitivities and specificities were found with sonography and scintigraphy. Tl-201/Tc-99m pertechnetate subtraction scintigraphy appears to be an accurate technique in identifying pathologic parathyroid enlargement. Its ultimate role in the evaluation of patients with suspected hyperparathyroidism still needs to be determined.
Asunto(s)
Neoplasias de las Paratiroides/diagnóstico por imagen , Adenoma/diagnóstico por imagen , Animales , Radioisótopos de Cesio , Perros , Humanos , Masculino , Persona de Mediana Edad , Glándulas Paratiroides/anatomía & histología , Hormona Paratiroidea/sangre , Radioisótopos , Cintigrafía/tendencias , Ratas , Selenometionina , Pertecnetato de Sodio Tc 99m , TalioRESUMEN
Eighteen patients who had elevated serum calcium and parathormone levels were prospectively studied with intravenous digital subtraction angiography (DSA). Intravenous DSA of the neck and mediastinum was performed in the anteroposterior, the left anterior, and the right anterior oblique projections. The study was considered positive if an abnormal blush or blood supply was noted. Upon operation, 14 patients were confirmed to have parathyroid adenomas, of whom five had positive preoperative DSA examinations. Four patients were followed medically (three negative DSA, one positive DSA). A positive intravenous DSA may be useful to guide neck explorations for parathyroid adenomas; however, the low sensitivity of the study may limit its screening potential.
Asunto(s)
Adenoma/diagnóstico por imagen , Angiografía Cerebral , Neoplasias de las Paratiroides/diagnóstico por imagen , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Técnica de SustracciónRESUMEN
A case is presented of a pituitary adenoma which was treated with radiation. Subsequently an empty sella developed and the dorsum sellae was found to be fractured forward. Possible etiological factors and the significance of this finding are discussed.
Asunto(s)
Adenoma/radioterapia , Fracturas Espontáneas/etiología , Neoplasias Hipofisarias/radioterapia , Radioterapia/efectos adversos , Silla Turca , Adulto , Humanos , MasculinoRESUMEN
PIP: Neither the report by Meyer and Abdel-Bari regarding thyrocalcitonin-like activity in an extract derived from a medullary carcinoma of the thyroid gland (March 7, 1968) nor the editorial summarizing the possible roles of thyrocalcitonin in relation to disease mentioned the most recent report of Williams and his associates. Their experience suggests that appreciable amounts of (PGs) prostaglandins were present in tumor tissue in 4 of 7 cases of medullary carcinoma of the thyroid. Elevated blood levels of PGs were detected in 2 of these patients--both of whom had diarrhea. Although the patient of Meyer and Abdel-Bari was not reported to have had this particular symptom, diarrhea has been described in association with a significant number of medullary carcinomas. The group of long-chain fatty acids classified as PGs has myriads of diverse activites in biologic systems. Stimulation of intestinal smooth muscle is 1 of these, and may be the reason for the otherwise unexplained intestinal hyperactivity. Also, since the assay for thyrocalcitonin is nonspecific, it is conceivable that some of the PGs have a similar acute hypocalcemic and hypophosphatemic effect, although this has apparently not been reported to date.^ieng