99mTc-MIBI SPECT과 경부 CT로 진단된 이소성 부갑상선 선종 1예
Primary Hyperparathyroidism with Ectopic Parathyroid Adenoma Detected by Both 99mTc-MIBI SPECT and Contrast-Enhanced Neck CT
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초록
이소성 부갑상선은 지속성 또는 재발성 부갑상선항진증의 주요 원인이므로 부갑상선수술의 성공은 정확한 수술전 위치파악에 따라 달려 있다. 본 증례는 처음 원발성 부갑상선 기능항진증 진단을 받았으나 부갑상선 국소화 검사에 일반적으로 이용되는 경부 초음파 검사와 99mTc-sestamibi scan으로 병변 국소화가 되지 않고 추적 소실되었다가 증상이 악화되어 내원한 52세 남자 환자에 관한 보고이다. 저자들은 초기에 부갑상선 국소화에 실패하였으나 99mTc-MIBI SPECT과 경부 CT를 병합하여 시행한 후 지속적으로 부갑상선 기능항진증을 유발하는 이소성 부갑상선 종양을 종격동내에서 발견하였고 성공적으로 수술하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
An ectopic parathyroid gland is a major cause of persistent and recurrent hyperparathyroidism. Surgical success depends on accurate preoperative localization of the parathyroid adenoma. We herein report the case of a 52-year-old male patient who suffered from primary hyperparathyroidism for several years. He initially presented with urinary frequency, hypercalcemia, and a ureter stone. Ultrasonography and a 99mTc-sestamibi scan were performed, but failed to localize the parathyroid lesion. Four years later, the patient revisited our hospital, complaining of general weakness, headache, dyspepsia, and recurrent urinary symptoms secondary to persistent primary hyperparathyroidism. In addition, renal function was decreased and severe osteoporosis was found. We performed a 99mTc-sestamibi scan with single photon emission computed tomography (99mTc-MIBI SPECT) and contrast- enhanced neck CT, and detected an ectopic parathyroid adenoma in the upper anterior mediastinum. In conclusion, the combination of both 99mTc-MIBI SPECT and neck CT could permit better preoperative parathyroid localization, especially for mediastinal adenomas. (Korean J Med 2012;83:641-646)
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