Endocrine Abstracts

JOINT908

Case History: We present a case of a 63-year-old female who presented with nausea, weight loss, constipation, low mood, and headache. The patient’s past medical history included rheumatoid arthritis and a fractured ankle. There was no previous history of renal stones, nor a family history of hypercalcemia. Blood tests revealed normal renal function, low vitamin D levels (which were sufficiently replenished), elevated adjusted calcium at 2.96 mmol/l(reference range: 2.2–2.6 mmol/L), elevated parathyroid hormone at 26.4 pmol/l(reference range: 1.6–6.9 pmol/L), and a urinary calcium-creatinine ratio of 2.23. Primary hyperparathyroidism (PHPT) was diagnosed. Although Sestamibi scan and parathyroid ultrasound did not identify parathyroid adenoma. However, A PET-CT with F18 choline identified a left inferior parathyroid adenoma. Additionally, renal ultrasonography detected a non-obstructive 4 mm kidney stone. The patient left inferior parathyroid adenoma was surgically removed and her symptoms and biochemistry improved, including serum calcium levels normalized to 2.25 mmol/L. In primary hyperparathyroidism (PHPT), surgical intervention is the only curative option when appropriate. Therefore, precise localization of the parathyroid adenoma is crucial for successful surgical management. Radiolabelled choline PET-CT has emerged as a novel imaging modality, demonstrating significant promise for accurate lesion localization. We note a series of ten patients in whom ultrasound and MIBI scans failed to detect definitive parathyroid adenomas. In all these cases, F18 choline PET-CT successfully identified the lesion, enabling curative surgical intervention. In fact, in two of the ten instances, a parathyroid adenoma was identified in the mediastinum and would have been overlooked if exploratory parathyroidectomy was undertaken. Recent research demonstrated that F18 choline PET-CT has a higher preoperative diagnostic efficiency than ultrasound and MIBI scans, with a positive predictive value of 90.9%. We propose F18 choline PET-CT as a primary imaging modality to augment, current imaging with Ultrasound, MIBI scintigraphy, and 4D CT, due to its superior diagnostic performance. However, further clinical research is needed, and cost as well as local availability remain important considerations.