Harinarayan C V
Sakra Hospitals, India
Scientific Tracks Abstracts: J Clin Case Rep
Introduction: The Commonest cause of primary hyperparathyroidism (PHPT) is hyper-functional parathyroid adenoma (PA) (94%) hyperplasia(<6%) rarely parathyroid carcinoma(<1%). Parathyroidectomy is a definitive cure with a success rate of 95 %. Less than 15% have one or more hyper-functioning glands in the ectopic location. Materials and Methods: Between 2014 to 2017, seven of the 13 patients with PHPT and failed non-invasive localization were included for the study. Hybrid localization techniques with PET/CT and newer tracer agents (11C-methionine) were used. Locations of parathyroid adenoma were classified using Perrier classification which uses letters A-G to describe the exact location of the adenoma. A 50 % drop in PTH levels as compared with pre-incision values was confirmed as cure. Results: The biochemical and hormonal profile of the 7 patients with ectopic PA are (mean+SD) serum calcium (mg/dl), 25OH-D (ng/dl) and PTH (pg/ml) 11.36+0.82;22.82+8.57; 205+105 respectively. Forty three percent (3/7) had renal stones. In all seven patients PA was localized using PET/CT scans and tracer agents 11C-choline. The profile of PA were two type-G (intra-thyroidal), one type-C (posterior mediastinum), two type-F (Superior mediastinum), one of type D(mid region of posterior surface of thyroid parenchyma at the junction of recurrent laryngeal nerve and the middle thyroidal vein). Conclusion: Ectopic PA is rare. In a biochemically and hormonally confirmed PHPT and failed imaging localization techniques/ failed neck exploration one should look for ectopic PA. Newer hybrid techniques combined with newer tracer agents (PET scan) will help in localization of PA. To the best of our knowledge this is the first report of series of ectopic PA from a single centre from India.
C.V. Harinarayan is an excellent clinician, accomplished researcher and scientist, astute bedside investigator, exemplary organizer and administrator. He has an outstanding contribution in the field of Endocrinology. His research work has provided new perspectives in the correct diagnosis and treatment of metabolic bone diseases.