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Endocrine Abstracts (2017) 49 EP297 | DOI: 10.1530/endoabs.49.EP297

ECE2017 Eposter Presentations: Calcium and Bone Calcium & Vitamin D metabolism (65 abstracts)

Tc-99m sestamibi uptake by brown tumours in a patient with primary hyperparathyroidism

Daniela Dias , Daniel Macedo , Rita Santos & Valeriano Leite


Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal.


Tc-99m sestamibi (MIBI) imaging is able to localize parathyroid adenomas/carcinomas in patients with primary hyperparathyroidism. Brown tumours are one of the skeletal manifestations of long standing hyperparathyroidism and its incidence has been reported to be 3%. Radiological features of these tumors may mimic bone metastasis. There are only a few reports showing brown tumours uptake in the whole-body Tc-sestamibi scan.

We report a 72-year-old female with a previous history of right nephrectomy for renal lithiasis at age 49 and a left clavicle mass fracture. A neck and thoracic computed tomography (CT) scan revealed multiple lytic lesions of the skeleton (including in the left clavicle) and a pathological mandibular fracture, suggesting metastatic lesions.

18F-FDG PET scan showed multiple skeletal hypermetabolic lesions and a hypermetabolic nodule close to left lower pole of the thyroid gland. The biopsy of the lesion in the left clavicle revealed histiocytic proliferation with multinucleated osteoclast-type giant cells compatible with a brown tumor. Laboratory data showed an elevated serum calcium of 12.8 mg/dl (8.4–10.2), alkaline phosphatase of 264 UI/l (9–36), and parathyroid hormone of 1056 pg/ml (12–65).

Tc-99m sestamibi scintigraphy showed an uptake in the inferior left pole of the thyroid and in multiple bone lesions. The patient underwent a left inferior parathyroidectomy. Histology revealed a 20 mm parathyroid adenoma.

In this patient with a long standing hyperparathyroidism the intense uptake of brown tumors in both 18F-FDG PET scan and MIBI can mimic a parathyroid carcinoma with bone metastases.

Volume 49

19th European Congress of Endocrinology

Lisbon, Portugal
20 May 2017 - 23 May 2017

European Society of Endocrinology 

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