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Related Concept Videos

The Parathyroid Glands00:59

The Parathyroid Glands

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The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...
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Hormones and Bone Tissue01:17

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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
Hormones That Influence Osteoblasts and/or Maintain the Matrix
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Skeleton and Calcium Homeostasis01:21

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Calcium is not only the most abundant mineral in bone but also the most abundant mineral in the human body. Calcium ions are needed for bone mineralization, tooth health, heart rate regulation and strength of contraction, blood coagulation, the contraction of smooth and skeletal muscle cells, and the regulation of nerve impulse conduction. The average calcium level in the blood is about 10 mg/dL. When the body cannot maintain this level, a person will experience hypo or hypercalcemia.
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Synthesis and Functions of Calcitonin00:51

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Calcitonin, a vital polypeptide hormone, regulates calcium levels within body fluids. It is released by the parafollicular cells, also known as C cells, situated in the follicular epithelium of the thyroid gland. Calcitonin responds to fluctuations in blood calcium levels and the influence of gastrointestinal hormones like gastrin and cholecystokinin.
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Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies01:28

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Peptic ulcer disease (PUD) presents with diverse symptoms depending on the location and severity of the ulcer. Clinical manifestations of peptic ulcer include dull pain and a burning sensation in the mid-epigastric region.
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The Thyroid Gland01:23

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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
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Related Experiment Video

Updated: Jun 4, 2025

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Localization in primary hyperparathyroidism.

Piyush Aggarwal1, Vinisha Gunasekaran1, Ashwani Sood1

  • 1Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India.

Best Practice & Research. Clinical Endocrinology & Metabolism
|January 4, 2025
PubMed
Summary

Accurate pre-operative localization of hyperparathyroidism, predominantly caused by parathyroid adenomas, is crucial for successful surgery. Advanced imaging like 99mTc-MIBI scans and 18F-Choline PET/CT improve diagnostic accuracy.

Keywords:
adenomahypercalcemiahyperparathyroidismhyperplasiaminimally invasive surgical procedurespositron emission tomography/ computed tomographyprimary

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Area of Science:

  • Endocrinology
  • Nuclear Medicine
  • Radiology

Background:

  • Primary hyperparathyroidism, a common endocrine disorder, is primarily caused by parathyroid adenomas or hyperplasia.
  • Hypercalcemia is the hallmark biochemical finding, necessitating accurate diagnosis and localization for effective management.
  • Pre-operative localization of abnormal parathyroid glands is essential for optimizing surgical outcomes.

Purpose of the Study:

  • To review and compare various non-invasive imaging modalities for pre-operative localization of parathyroid glands in primary hyperparathyroidism.
  • To evaluate the diagnostic performance of functional imaging techniques, including radionuclide scintigraphy and PET/CT, in identifying parathyroid pathology.
  • To highlight the role of advanced imaging in complex cases such as ectopic adenomas, persistent/recurrent hyperparathyroidism, and concurrent thyroid disease.

Main Methods:

  • Review of current non-invasive imaging techniques: cervical ultrasound, 99mTc-Methoxyisobutyl isonitrile (MIBI) scintigraphy with SPECT/CT, 4DCT, MRI, and 18F-Choline PET/CT.
  • Analysis of functional imaging accuracy, particularly for ectopic, persistent, or recurrent parathyroid adenomas.
  • Comparison of combined imaging modalities (e.g., ultrasound and 99mTc-MIBI) versus individual techniques.
  • Assessment of 18F-Choline PET/CT and PET/MRI for hyperplasia and multiple adenomas.
  • Consideration of 4DCT in equivocal cases and concurrent thyroid disease.

Main Results:

  • Functional imaging, including 99mTc-MIBI scintigraphy and 18F-Choline PET/CT, demonstrates high accuracy in localizing parathyroid adenomas, especially in challenging cases.
  • Combined ultrasound and 99mTc-MIBI scintigraphy offers superior sensitivity and specificity compared to either modality alone.
  • 18F-Choline PET/CT shows enhanced diagnostic performance for parathyroid hyperplasia and multiple adenomas.
  • 18F-Choline PET/MRI and 4DCT aid in characterizing lesions in patients with equivocal findings or concurrent thyroid nodular disease.
  • Intraoperative probe-guided surgery improves the success rate of targeted, minimally invasive procedures.

Conclusions:

  • Accurate pre-operative localization using advanced imaging modalities is critical for successful surgical management of primary hyperparathyroidism.
  • Functional imaging techniques, particularly 18F-Choline PET/CT and combined modalities, significantly improve diagnostic yield.
  • Further development of more specific radiopharmaceuticals is needed to reduce false-positive results and enhance imaging precision.