Hyperplasia of all four parathyroid glands in renal failure visualized by Tc-99m tetrofosmin scintigraphy.

Key words: hyperparathyroidism-radionuclide-imaging; primary and secondary hyperparathyroidism [1–3]. With hyperplastic parathyroid glands tetrofosmin hyperplasia; Technetium-99m-diagnostic use; tetrofosmin imaging gives an overall sensitivity of 84% and a specificity of 75%, higher than those of Tc-99m sestam-ibi, ultrasonography and magnetic resonance imaging Renal history [1–2]. The former has demonstrated a low sensitivity for localization of hyperplastic glands in secondary hyperparathyroidism (31%) [3]. A 21-year-old woman had been on haemodialysis since Four ectopic hyperplastic parathyroid glands have 1994. Renal failure was caused by reflux nephropathy been diagnosed by Tc-99m sestamibi [4], and thallium-and recurrent urinary infections secondary to obstruct-technetium subtraction scanning has localized four ive uropathy. She underwent bilateral nephrectomy in 'eutopic' hyperplastic glands [5]. Hyperplasia of all 1995 and received a cadaver renal transplant in 1996. four eutopic parathyroid glands has only rarely been One year later, the graft was removed following renal visualized and, to our knowledge, this is the first case artery occlusion. visualized by Tc-99m tetrofosmin. The inconvenience of other imaging techniques (low sensitivity for detection of glands and deficiency with regard to predic-Parathyroid gland history tion of multiple parathyroid involvement) has not been encountered with Tc-99m tetrofosmin in this Secondary hyperparathyroidism was diagnosed in patient. 1994. Following the renal transplant, the parathyroid gland function became normal. In 1998 her intact PTH level in serum on three occasions ranged from 2482 to 4127 pg/ml (normal range 15–60 pg/ml). Technetium-References 99m (Tc-99m) tetrofosmin parathyroid scintigraphy showed abnormal focal areas of increased uptake in 1.each of the four thyroid poles. These areas were not 99m-tetrofosmin, ultrasound and MRI for localization of abnor-visualized by Tc-99m pertechnetate, suggesting four mal parathyroid glands. hyperplastic parathyroid glands (Figure 1). 2. Ishibashi M, Nishida H, Strauss HW et al. Localization of Subsequently at parathyroidectomy four glands, each parathyroid glands using technetium-99m-tetrofosmin imaging. of the thyroid, and histology showed 'nodular and Technetium 99m tetrofosmin parathyroid imaging. Results with diffuse hyperplasia of chief cells'. double-phase study and SPECT in primary and secondary hyper-parathyroidism. Discussion 5. Thompson CT, Bowers J, Broadie TA. Preoperative ultrasound and thallium-technetium subtraction scintigraphy in localizing Tc-99m tetrofosmin parathyroid imaging is a useful parathyroid lesions in patients with hyperparathyroidism.