Case History
A 42 year old male found to be hypercalcemic by multi channel blood chemical analysis during an annual physical examination. On questioning, there was no symptomatology of hyperparathyroidism other than increased fatigue. Repeat blood calcium levels ranged from 11.5 to 12.0 ml/dl. Intact parathyroid hormone assay was 78.9 pg/ml (normal range 10.0-65.0). Twenty-four hour urinary calcium was 366 ml/24 hours (normal range 100-300). Bone density: lumbar spine showed severe osteoporosis, left femoral neck and left hip suggest moderate to severe osteopenia. Neck exploration was recommended and accepted by the patient. Preoperative technetium sestamibi scan showed abnormal uptake in the left upper parathyroid location.
On the day of surgery the patient received another dose of technetium sestamibi. The technetium assists the surgeon in locating the abnormal gland in the neck. The patient was taken to the operating room 90 minutes post-sestamibi injection. Gamma probe readings in three quadrants of the neck in the paratracheal area were essentially the same in the 650 range. The gamma probe reading in the upper left paratracheal area was in the 850 range. A 2.5-3 cm incision was made in the skin just below the area with the highest gamma probe readings. Dissection in that area guided by the gamma probe revealed large 2 cm adenoma. The gamma probe reading just before identification of the gland was 1500. It took 20 minutes from the time of incision to identify and remove the abnormal gland.
The incision was closed without drains. A serum calcium level obtained four hours following surgery was within the normal range. The patient was discharged with instructions regarding wound care, pain medication, and arrangements for an additional serum calcium level to be obtained the next day.
