Interesting Images

Four Atypical Parathyroid Adenomas Detected by Dual Phase Tc-99m MIBI SPECT


  • Mine Araz
  • Derya Çayır
  • Fatma Fulya Köybaşıoğlu
  • Harun Karabacak
  • Erman Çakal

Received Date: 14.04.2018 Accepted Date: 07.02.2019 Mol Imaging Radionucl Ther 2020;29(1):33-36 PMID: 32079386

We report a case of a 55-year-old female with tertiary hyperparathyroidism and osteoporosis who had end stage renal disease and a history of hemodialysis for 15 years. Patient’s informed is taken. Neck ultrasonography showed multinodular goiter together with a hypoechoic lesion compatible with a parathyroid adenoma. Dual phase technetium (Tc) Tc-99m MIBI single photon emission computed tomography (SPECT) showed pathological uptake in four parathyroid gland locations. Total thyroidectomy and subtotal parathyroidectomy revealed nodular hyperplasia and atypical adenomas in four parathyroid glands. Atypical parathyroid adenoma is a rare clinical entity. Multiple atypical adenomas are even less frequent. A very rare condition, detection of atypical adenomas in four of the parathyroid glands by dual phase Tc-99m MIBI SPECT, is presented in this case.

Keywords: Parathyroid gland, parathyroid adenoma, Tc-99m sestamibi, single photon emission computed tomography


Informed Consent: Informed consent was taken.

Peer-review: Externally and internally peer-reviewed.

Authorship Contributions

Surgical and Medical Practices: H.K., E.Ç., F.F.K., Concept: M.A., Design: M.A., Data Collection or Processing: D.Ç., Analysis or Interpretation: M.A., Literature Search: D.Ç., Writing: M.A.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.


  1. Sheu-Grabellus SY, Schmid KW. Pathology of parathyroid glands: Practical aspects for routine pathological investigations. Pathologe 2015;36:229-236.
  2. Carlson D. Parathyroid pathology: hyperparathyroidism and parathyroid tumors. Arch Pathol Lab Med 2010;134:1639-1644.
  3. Piga M, Bolasco P, Satta L, Altieri P, Loi G, Nicolosi A, Tarquini A, Mariotti S. Double phase phase parathyroid technetium-99m- MIBI scintigraphy to identify functional anatomy in secondary hyperparathroidism. J Nucl Med 1996;37:565-569.
  4. Torregrosa JV, Fernández-Cruz L, Canalejo A, Vidal S, Astudillo E, Almaden Y, Pons F, Rodriguez M. (99m)Tc-sestamibi scintigraphy and cell cycle in parathyroid glands of secondary hyperparathyroidism. World J Surg 2000;24:1386-1390.
  5. Taïeb D, Ureña-Torres P, Zanotti-Fregonara P, Rubello D, Ferretti A, Henter I, Henry JF, Schiavi F, Opocher G, Blickman JG, Colletti PM, Hindié E. Parathyroid scintigraphy in renal hyperparathyroidism: the added diagnostic value of SPECT and SPECT/CT. Clin Nucl Med 2013;38:630-635.
  6. Ruda JM, Stack BC Jr, Hollenbeak CS. The cost-effectiveness of additional preoperative ultrasonography or sestamibi-SPECT in patients with primary hyperparathyroidism and negative findings on sestamibi scans. Arch Otolaryngol Head Neck Surg 2006;132:46-53.