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A 73 y/o WF with primary
hyperparathyroidism who came to the clinic on 1/5/2005 for a follow
up visit. She still complains of excessive fatigue, weakness and
extremity pain which has been gradually progressive.
Social History: Does not smoke. Drinks socially. Married with
several children.
Family History: Maternal grandmother had loss of energy in her 60’s.
No family history of neck surgeries or hypercalcemia.
Past Medical History: HTN, diabetes-2, allergic rhinitis, elevated
calcium.
Current Mediations: Atenolol, Triamterene, HCTZ, omeprazole 20mg
daily, Nitrophenyl 50mg daily, Norvasc 10mg daily, Avandia 8mg
daily, Glipizide ER, Lipitor 20mg daily, Humulin N 15 units at bed
time, Allegra, Lisinopril 20mg daily, Nasonex, Zoloft 50mg daily.
Physical Exam: BP 183/66 Wt 198 lb P 88
Neck exam showed no lymphadenopathy or masses.
LABS:
12/8/2004 Ca 11.0 mg/dL (8.7-10.5) 1/5/2005 Ca 10 mg/dL
Ca, ionized 5.8 mg/dL (4.7-5.2) Ca, ionized 5.6 mg/dL
PTH, intact 39.9 pg/mL (10-65) PTH, intact 109.3 pg/mL
Sestamibi Scan
Exam: Parathyroid Localization Reason: Elevated Calcium
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| 15 min |
90 min |
Planar images of the neck were obtained at 15 minutes and 90 minutes
after injection of 27.4 mCi Tc-99m Sestamibi.
There was persistent abnormal increased activity within the neck
projecting over the inferior pole of the left lobe of the thyroid.
This finding is consistent with presence of a parathyroid adenoma;
Left inferior pole parathyroid adenoma.
Ultrasound on 1/5/2005:
Showed a 0.8 cm in diameter parathyroid gland in the left lower
lobe, which was quite deep in the neck behind the sternoclavicular
joint. This situation may not justify surgery and its risk,
including and not limited to recurrent laryngeal nerve injury and
the risk of bleeding in the neck, especially under local anesthesia.
Treatment options were discussed and minimally invasive surgery
under local anesthesia was her choice.
Submitted by Rhonda Hunkapiller, 2005
PharmD candidate
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© 2005 Nuclear Education Online
- Images courtesy of University
of Arkansas for Medical Sciences Dept of Nuclear Medicine.
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