TITLE:
11C-Choline PET/CT in the Management of Primary Hyperparathyroidism
AUTHORS:
Maria R. Alvarez, Rodrigo Arrangoiz, Miguel Ángel Olarte, Cecilia Carreras, Maria M. León S., Fernando Cordera
KEYWORDS:
Primary Hyperparathyroidism, Evaluation of Primary Hyperparathyroidism, 11C-Choline, 18F-Fluorocholine, PET/CT, Treatment of Primary Hyperparathyroidism
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.9 No.5,
July
28,
2020
ABSTRACT: Primary hyperparathyroidism (PHPT) is a relative common medical problem caused by the inappropriate secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The diagnosis is established by serum calcium and PTH levels and once the diagnosis is established imaging studies help localize the hyperfunctioning adenoma in preparation for curative surgery. Until now, the imaging studies most commonly utilized in PHPT are ultrasonography and 99mTc-Sesta-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. However, these studies often fail to localize the adenoma and inappropriately delay patient referral to a potentially curative surgery. We present the case of a 64-year-old female with symptomatic PHPT who had 3 negative 99mTc-Sestamibi Scans over a period of 5 years who eventually had a PET/CT with 11C-Choline that identified a right lower parathyroid adenoma. She underwent a right lower parathyroidectomy and had a successful outcome. We present a review the current imaging techniques used in the management of PHPT including 99mTc-Sesta-MIBI scintigraphy and its limitations and novel use of PET/CT with 11C-Choline and 18F-Choline in this disease and emphasize the fact that, according to current guidelines, failure to localize the adenoma should not delay referral for curative surgery.