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Hyperparathyroidism in pregnancy and 99mTc-MIBI scintigraphy
E Malheiro1, N Chabbert-Buffet2, J-N Talbot3
1Service d'OtoRhinoLaryngologie et de Chirurgie Cervicofaciale, Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Faculté de Médecine Sorbonne Université, Assistance publique-hôpitaux de Paris (AP-HP), Paris, France.
Summary
Primary hyperparathyroidism in pregnancy requires careful management. Ultrasound alone may suffice for localization, but a multidisciplinary approach ensures safe radiopharmaceutical selection when needed for parathyroid adenoma surgery.
Area of Science:
- Endocrinology
- Surgical Oncology
- Radiology
Background:
- Primary hyperparathyroidism (PHPT) in pregnancy poses risks to mother and fetus.
- Minimally invasive surgery is recommended for PHPT during pregnancy.
- Preoperative localization typically uses ultrasound (US) and scintigraphy, but radiopharmaceutical use in pregnancy requires caution.
Observation:
- A 4-month pregnant patient with severe PHPT had failed US localization.
- A multidisciplinary team opted for 99mTc-sestamibi scintigraphy over 18-fluorocholine PET/CT.
- Scintigraphy identified a hyperfunctioning right inferior parathyroid adenoma.
Findings:
- Successful surgical removal of a large right paravertebral parathyroid adenoma.
- Postoperative normalization of serum parathyroid hormone and calcium levels.
- Delivery of a healthy infant at term with normal calcium and TSH levels.
Implications:
- Ultrasound alone can be sufficient for parathyroid gland localization in pregnant patients.
- A multidisciplinary approach is crucial for selecting safe radiopharmaceuticals when US is insufficient.
- Minimally invasive surgery for PHPT in pregnancy can yield favorable maternal and fetal outcomes.
