• Advances in pediatric surgery
• /
• 제6권1호
• /
• pp.68-69
• /
• 2000

A case of primary hyperparathyroidism due to parathyroid adenoma is presented. A 14 year-old male was admitted to the hospital comptaining of voiding difficulty. The intravenous pyelogram demonstrated a stone in the proximal one third of the left ureter and marked hydronephrosis of the left kidney. The Tc-99m sestamibi nuclear scan demonstrated a hot spot below the lower pole of the left lobe of the thyroid. Laboratory study demonstrated hypercalcemia (12.4 mg/dL) and elevated parathyroid hormone (143.67 pg/mL). A parathyroid gland located below the lower pole of the left lobe of the thyroid was excised. A parathyroid adenoma, consisting of mainly chief cells was found on pathologic examination. Postoperatively the patient had transient hypocalcemic symptoms, which resolved with administration of calcium preparation and vitamin D.

• 대한핵의학회지
• /
• 제29권4호
• /
• pp.465-472
• /
• 1995

목적 : 원발성 부갑상선기능 항진증의 대부분의 원인인 부갑상선 선종의 유일한 완치는 수술이며 수술의 성패에 가장 중요한 것은 수술전의 정확한 ??소의 확인이다. 다양한 영상검사들이 동원되고있으나 각가 결점이 있고 가장 특이도가 높은 $^{201}T1-^{99m}Tc$감영 촬영방법도 검사방법등에 문제점이 있다. 이에 원발성 부갑상선기능 항진증 환자에게 최근에 사용되고있는 $^{99m}Tc$-Sestamibi 부갑상선 스캔의 유용성을 알아보고자 하였다. 대상 및 방법 : 19명의 부갑상선기능 항진증환자에서 모든 환자에게 초음파 검사, CT, $^{201}T1-^{99m}Tc$감영 촬영을 시행하고 그중 5명은 $^{99m}Tc$-Sestamibi 부갑상선 스캔을 시행하여 수술후 확진결과와 함께 비교하였다. 결과 : 초음파 검사와 CT 및 $^{201}T1-^{99m}Tc$감영 스캔은 19예중 각가 12예(67.1%), 14예(78.9%) 그리고 17예(89.5%)에서 병소확인이 가능하였고 $^{99m}Tc$-Sestamibi 부갑상선 스캔은 시행한 5예(100%) 모두에서 병소 확인이 가능하였다. 결론 : 이상의 결과로 $^{99m}Tc$-Sestamibi 부갑상선 스캔은 원발성 부갑상선기능 항진증의 수술전 병소확인에서 유용한 검사법으로 이용될 수 있으리라 사료된다.

• 대한두경부종양학회지
• /
• 제26권1호
• /
• pp.9-13
• /
• 2010

Background and Objectives : Parathyroid adenoma is a rare disease in Korea, but the incidence of parathyroid adenoma has gradually increased due to generalized measurement of serum calcium and imaging study according to wide spread public health screening program. In previous researches, the analysis of clinical aspects were insufficient due to a few cases. The purpose of this study was to assess the clinical analysis of surgically treated parathyroid adenoma with hyperparathyroidism. Methods : We reviewed the medical records of nineteen cases of parathyroid adenoma with hyperparathyroidism. Initial symptom to visit hospital, hypercalcemia associated medical symptom, surgical outcome and complication were investigated. Serum total calcium, parathyroid hormone, phosphate, alkaline phosphatase were checked before and after surgery. Imaging study was performed with combination of radionuclide parathyroid scan, ultrasonography and neck CT scan. Results : The initial symptoms were no symptom(6/19), pelvic pain(5/19), muscular weakness (3/19), bone pain(3/19) and palpable neck mass(2/19) in order of frequency. Serum total calcium, parathyroid hormone decreased and phosphate increased after surgery than before surgery statistically significantly. Sensitivities of parathyroid scan, neck ultrasonography and neck CT as preoperative localization test were 88.2%, 72.7%, 73.3% each. The most common postoperative complication was transient hypocalcemia(9/19). Conclusion : Similar to previous study, parathyroid adenomas have numerous clinical features and surgical treatment via unilateral approach with preoperatively localized single parathyroid adenoma was successful. In our study, parathyroid adenoma was predominantly detected by elevated serum calcium level with no clinical symptom so we need to evaluate parathyroid adenoma, if serum calcium elevated.

• 대한두경부종양학회지
• /
• 제39권2호
• /
• pp.27-30
• /
• 2023

A 65-year-old patient who underwent total thyroidectomy 10 years ago was suspected of having a parathyroid adenoma, and minimally invasive parathyroidectomy was planned. Preoperative ultrasonography(USG) and 99mTc MIBI scan indicated a left lower parathyroid lesion. In the first operation, intraoperative parathyroid hormone monitoring (IOPTH) was not possible due to hospital circumstances. Although no adenomatous lesion was found in the expected surgical field, surgery was completed after removing lesions around the left lower parathyroid gland. However, post-surgery, parathyroid hormone did not decrease at all, so a second operation was performed with IOPTH preparation. In the second operation, intraoperative ultrasonography was performed, and a suspected adenoma lesion was removed from the left upper lesion. He has been under follow-up for 3 years without complications. Surgeon-peformed intraoperative USG and preoperative scintigraphy had advantages in determining the localization of parathyroid lesion even withiout IOPTH.

• 대한정형외과학회지
• /
• 제55권1호
• /
• pp.54-61
• /
• 2020

목적: Brown 종양은 부갑상선 항진증으로 발생할 수 있는 종양 유사 질환으로 골다공증과 병적 골절을 일으킬 수 있다. Brown 종양에 대하여 지금까지 증례 보고로 발표되고 있으나 정확한 진단 및 골병변에 대한 치료 방침에 대한 포괄적인 보고는 없는 실정이다. 본 연구에서 저자들은 조직학적으로 증명된 다섯 증례의 Brown 종양에 대한 임상적 고찰을 통하여 진단, 치료 및 그 결과에 대해 보고하고자 한다. 대상 및 방법: 2004년 2월부터 2015년 5월까지 조선대학교병원 및 전남대학교병원 정형외과에서 Brown 종양으로 진단된 5개의 증례를 대상으로 의무 기록 및 영상 검사 등을 후향적으로 검토하였다. 치료 방법으로 전체 예에서 부갑상선 종양을 발견하여 수술적 치료를 시행하였으며, 정형외과적 병변에 대해서는 수술적 치료 및 관찰 요법을 시행하였다. 결과: 증상을 호소하는 골병변의 장축의 크기는 평균 6.2 cm (4.5-9.0 cm)였다. 전신 골주사 검사상 평균 7.6군데(3-14군데)에서 대사가 증가된 골병변이 발견되었으며, 에너지 방사선 흡수 계측법을 이용한 골밀도 검사상 척추와 근위 대퇴골에서 절대값, T-값과 Z-값이 진단 시 골다공증에 합당하다가 최종 추시 시 정상으로 회복되었다. 혈액학적 검사상 혈청 총 칼슘, 혈청 이온화 칼슘, 혈청 무기성 인, 혈청 알칼라인포스페이트, 부갑상선 호르몬 혈중 농도가 Brown 종양 진단에 도움이 되었으며, 성공적인 부갑상선 선종 또는 암 제거 시 정상화되었다. 결론: Brown 종양의 진단을 위하여는 임상 증상, 혈액학적 검사 및 골병변에 대한 영상의학적 검사의 포괄적인 이해와 분석이 필요하며, 부갑상선 기능 항진증에 대한 치료와 함께 골병변에 대해서는 그 위치와 크기, 진행 정도를 고려한 적절한 치료가 반드시 병행되어야만 한다.

• 대한두경부종양학회지
• /
• 제12권1호
• /
• pp.58-64
• /
• 1996

The parathyroid adenoma is the most common cause of the primary hyperparathyroidism. The characteristic of primary hyperparathyroidism is hypercalcemia and high value of serum parathyroid hormone. The primary hyperparathyroidism with parathyroid adenoma is treated by excision of parathyroid gland involved. Especially, parathyroid storm in patients with primary hyperparathyroidism is more prevalent than commonly appreciated. The symptoms and signs of the syndrome are not only due to the hypercalcemia, but also to the toxic effects of the parathyroid hormone. Its wide, but nonspecific clinical presentations make it easily confused with other cardiovascular or renal diseases. The mortality rate in untreated cases of parathyroid storm is essentially 40%. A 33 year old woman with primary hyperparathyroidism was found to have a left lower parathyroid adenoma, presented with hypercalcemic crisis. Initially, good responsiveness to a saline infusion, furosemide administration was noted. Unfortunately, she became consciousness disturbance after fine-needle aspiration of the parathyroid tumor. The recurrent storm was refractory to medical therapy, but was treated succesfully by emergent surgical removal tumor revealed a parathyroid adenoma with parathyroid hormone. Hypercalcemia was alleviated postoperatively. These observations corroborated a functioning parathyroid adenoma.

• 대한핵의학회지
• /
• 제21권1호
• /
• pp.75-78
• /
• 1987

A 57 year old female patient was diagnosed as primary hyperparathyroidism after incidental finding of hypercalcemia. She was treated with radioiodine for Graves disease twenty years ago. Preoperative localization procedures with sonography and CT were unrevealing but 201 thallium scintiscan clearly demonstrated ectopic parathyroid adenoma which was confirmed by surgery. Brief review of the preoperative parathyroid localization procedure was done and the relationship between radioiodine therapy and hyperparathyroidism was discussed.

• 대한두경부종양학회지
• /
• 제15권1호
• /
• pp.80-84
• /
• 1999

Primary hryperparathyroidism is a relatively rare disease entity in Korea. It's characterized by severe skeletal and renal changes due to hypersecretion of parathyroid hormone, and rarely shows peptic ulceration, hypertension, pancreatitis and impaired mentality. Recently the determination of the serum calcium level has become a routine laboratory test and the awareness of primary hyperparathyroidism has been incerased, the disease is being diagnosed with increasing frequency. Primary hyperparathyroidism is most commonly caused by parathyroid adenoma and rarely hyperplasia, cancer of parathyroid glands. The authors operated sucessfully a case of primary parathyroid adenoma by diagnosed by nuclear medical diagnostic work-up. The patient had anterior neck mass(soft, non tender nodule) on physical examination, multiple goiter on thyroid ultrasonogram and scan. The parathyroid lesion was difficult to find preoperatively.

• 대한두경부종양학회지
• /
• 제37권2호
• /
• pp.101-104
• /
• 2021

Spontaneous cervical hematomas could lead to life-threatening complications, and aneurysms, retopharyngeal abscesses, parathyroid adenomas, laryngeal cysts, and neurogenic tumors should be distinguished as possible underlying causes. Symptoms accompanying spontaneous cervical hematoma include cervical swelling, ecchymosis, dysphagia, dyspnea and hoarseness. We recently experienced a case of spontaneous cervical hematoma in a 52-year-old woman, who initially presented with cervical swelling after severe coughing two days ago. Resultingly parathyroid adenoma was finally confirmed after mass excision. Therefore, we present this unique case with a review of the literature.

• 대한핵의학회지
• /
• 제28권1호
• /
• pp.31-36
• /
• 1994

$^{201}Tl-^{99m}Tc$ 감영스캔이 시행되었던 65명의 환자에서 $^{201}Tl-^{99m}Tc$ 감영스캔의 진단적 가치와 위 음성과 위 양성의 원인에 대해 조사하였다. 이들 중 21예가 부갑상선선종으로 확진되었고, 이들에서 $^{201}Tl-^{99m}Tc$ 감영스캔의 예민도는 90.5%, 특이도는 97.6%였다. 위 음성을 보인 예는 낭종성 괴사를 보인 부갑상선선종과 크기가 $1.5{\times}1{\times}0.8 cm$ 정도로 작은 종양이었다. 위 양성을 보인 1예는 무 기능성 갑상선종이었다. 결론적으로 $^{201}Tl-^{99m}Tc$ 감영스캔은 부갑상선 종괴를 찾아내는데 특이도와 예민도가 높은 검사로 생각된다.