Parathyroid adenoma

A 74-year old female showed abnormal hypercalcemia on pre-operative lab (she was scheduled to have TKRA)

Neck sonography was asked to rule out primary hypercalcemia

• Parathyroid gland
  • 35-40mg
  • Yellow
  • Supplied from end artery (esp. ITA branch)
  • Inferior parathyroid gland – 3rd branchial pouch ; long migration path makes more ectopic location of it
  • Superior parathyroid gland – 4th branchial pouch

• Parathyroid adenoma is a benign tumor of the parathyroid gland and the most common cause of primary hyperparathyroidism
  – The cause of primary hyperparathyroidism ; Parathyroid adenoma (80-85%), primary parathyroid hyperplasia (15%), parathyroid carcinoma(5%)
  

• Clinical presentation
  • Non-specific symptoms (fatigue, weakness)
    • Elevated serum calcium levels and elevated serum parathyroid hormone levels
      
• US features
  • Hypoechoic solid mass with oval, bean-like or multilobulated shape
  • **cystic degeneration in 2%
  • Color or power Doppler US
    – Polar feeding artery to one pole generally from inf. thyroidal artery
    – Location Posterior or inferior to thyroid gland
    
• Nuclear medicine
  • 99mTc-sestamibi SPECT (photon energy: 140 KeV)
    – Diffuse passively across cell membrane, concentrate in mitochondria
  • Parathyroid adenomas are best demonstrated on delayed imaging (1-2 hours)

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