Parathyroid tumors: Preoperative localization and association with other tumors

Abstract

Preoperative localization of hyperfunctioning parathyroid tissue with venous catheterization for venous blood sampling and parathyroid thermography was done in 23 patients with hypercalcemia. The elevated levels of PTH, and the unilateral and bilateral PTH gradient in the thyroid venous blood samples permitted correct localization of the hyperfunctioning parathyroid tissue in 20 patients. The other 3 patients had a peak level of PTH in the left innominate vein blood. The parathyroid adenoma in 2 of these patients was found on the right side; this was attributed to the drainage of the right thyroid vein into the left innominate vein. In the 3rd patient, the hyperfunctioning parathyroid tissue was not found at surgery, but the mediastinum and the paraesophageal area were not investigated. Sixteen of these patients were studied by thermography of the neck, and 6 showed the correct localization. Ten of the 23 patients studied had neoplasms in other organs while 3 other patients belonged to a family with pluriglandular syndrome. These data indicate: A) radioimmunoassay of plasma PTH from selectively cathetherized thyroid veins and large neck veins gave the correct preoperative localization in the majority of patients with hyperfunctioning parathyroid tissue; B) a peak level of PTH in the left innominate vein may indicate left or right hyperfunctioning parathyroid tissue; C) primary hyperparathyroidism should be considered as one of the causes of hypercalcemia found in patients with neoplasia; and D) hyperparathyroidism may be familial and associated with pluriglandular syndrome.