Tc-99m sestamibi scintigraphy and primary hyperparathyroidism: uptake beyond parathyroid glands

Description 

Brown tumours (BTs) are one of the complications of long-standing hyperparathyroidism, being rare in developed countries. Tc-99m sestamibi scintigraphy (MIBI) is currently the gold standard for eutopic/ectopic parathyroid tissue localisation in primary hyperparathyroidism (PH). There are only a few reports showing BT uptake in whole-body MIBI.1–3

The first case is a 72-year-old caucasian woman, with a history of right nephrectomy for renal lithiasis at the age of 49 and a left clavicle fracture at the age of 70, who presented with an enlarging mass in the fracture site (~6 cm). Laboratory data showed an elevated serum level of calcium (sCa) of 12.8 mg/dL [normal range (NR): 8.4–10.2], alkaline phosphatase (ALP) of 264 UI/L (NR: 9–36) and parathyroid hormone (PTH) of 1056 pg/mL (NR: 12–65), and decreased serum phosphorus (sPi) of 2.1 mg/dL (NR: 2.3–4.7) with 25-OH vitamin D of 33 ng/mL (NR 9–45), consistent with PH. MIBI showed uptake in the inferior pole...

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