1 / 20

Parathyroid gland

Parathyroid gland. M. Alhashash. Anatomy . Anatomy . Physiology . Parathyroid Imaging. Tc-99m sestamibi scan ( Cardiolyte ) Ultrasound Initially thought useful only in persistent or recurrent disease. Thallium-technetium subtraction scan - now rarely used.

valora
Download Presentation

Parathyroid gland

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Parathyroid gland M. Alhashash

  2. Anatomy

  3. Anatomy

  4. Physiology

  5. Parathyroid Imaging • Tc-99m sestamibi scan (Cardiolyte) • Ultrasound • Initially thought useful only in persistent or recurrent disease. • Thallium-technetium subtraction scan - now rarely used

  6. Parathyroid Imaging -Tc-99m Sestamibi 45 min Anterior 45 min LAO submandibular gland thyroid lobe adenoma Delayed views 2 HR 2 HR

  7. Disorders of Parathyroid Glands • Hypoparathyroidism-rare. Almost always caused by excessive surgical removal of parathyroid tissue (iatrogenic) during thyroid or parathyroid surgery • Hyperparathyroidism (HPT): • primary - high Ca++, high PTH - usually due to single adenoma (90%), cured by removal of adenoma • secondary - low Ca++, high PTH, seen in chronic renal failure - not a surgical problem • tertiary - high Ca++, high PTH, seen after renal transplant - hyperplasia of all 4 glands

  8. Primary hyperparathyroidism • The commonest. • Autonomous production of PTH. • Pathology: • Neoplasm(85%). • Adenoma (80%) usually single gland • Carcinoma (5%) usually associated with hyperplasia or adenoma. • Hyperplasia(15%)usually 4 glands and may be associated with MEN syndrome.

  9. Primary hyperparathyroidism • Clinically: • Females > males • Symptoms of hypercalcaemia. • Abdomen: anorexia, nausia, vomiting, hypotonia---peptic ulcer---pancreatitis. • Renal: stones , polyuria , nephrocalcinosis, renal failure, hypertension. • Skeletal: intense bone resorption, pathological fractures, calcification of cartilages and pain. • Psychotic: apathy, drowsiness and depression. • General : weakness, pruritis, neuropathy, numbness, thirst, salivary gland calculi. • Hypercalcaemic crisis: Ca > 15mg % confusion and coma.

  10. Investigations • Hypercalcaemia (normal Ca 9.2 – 10.4mg%). • Hypophosphataemia. • PTH • Plain x-ray bone and stones • U/S, CT , MRI, • Isotope scanning

  11. Treatment • Hyperplasia subtotal parathyroidectomy. • Adenoma resection of the affected gand/s. • Carcinoma: hemithyroidectomy with the gland followed by radiotherapy. • Hypercalcaemic crisis : I.V. phosphate, calcitonin, saline and diuretics .

  12. Secondary hyperparathyroidism. • In chronic renal failure - hypocalcaemia-hyperplasia of the gland. • Clinically : mainly bone resorption. • Treatment: mainly medical • Restriction of phosphate. • Calcium. • Vitamin D. • surgery only in severe cases by subtotal parathyroidectomy • Localization as primary.

  13. Tertiary hyperparathyroidism • After renal transplantation • Sever bone manifestation. • Subtotal parathyroidectomy.

  14. Traditional Surgery for Hyperparathyroidism • primary HPT - 4 gland exploration, remove adenoma, biopsy 3+ normal glands • tertiary HPT (after renal transplantation) - 3 1/2 gland removal +/- forearm autotransplant

  15. Complications of Parathyroid Surgery • persistent HPT - 1-20% (experience dependent) • temporary or permanent hypocalcemia - 1-20% • nerve injury - recurrent or superior laryngeal -1-10% • bleeding - <5%

  16. Unilateral Exploration for Primary HPT • if: one abnormal, hypercellular gland and one normal gland found on one side, no contralateral exploration • occasional use of preop thallium-technetium scan • results of 5 studies - cure 93-100%

  17. Parathyroid gland Thank you

More Related