Innovative Approach of Endosonographic Radioactive Labeling of an Ectopic Parathyroid Adenoma by Technetium-99m Human Serum Albumin: A Case Report

Primary hyperparathyroidism caused by parathyroid adenoma requires surgical resection. To confine the extent of surgery to very minimum and exclude an atypical location, preoperative imaging aims at identifying suspicious gland. For this purpose, Technetium-99m (99mTc)-sestamibi scintigraphy SPECT have become international standard, in inconclusive cases also with C-11 methionine F-18 choline PET/CT. We present a case for ectopic retroesophageal resected under gamma probe guidance after radioactive targeting. A 73-year-old patient, who was diagnosed primary hyperparathyroidism, presented our outpatient clinic. The patient symptom-free, but during routine check-up, parathormone levels 127 pg/ml (normal range 15-65) were detected. Parathyroid MIBI scintigraphy, including SPECT/CT, failed locate adenoma. Therefore, PET/MRI scan 164 MBq applied single detected untypical prevertebral position, respectively. Due its esophageal proximity enable confined surgery, endosonography performed transesophageally injected 75 99mTc-human serum albumin (HSA). next day probe-guided minimally invasive resection without any intra- or postoperative complications. Minimally adenomas should be standard may difficult deep collar locations. Marking nanocolloid tracer can considered innovative approach maintain minimal therapy adenomas.