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| | | There are three types of hyperparathyroidism and should be differentiated between each other. Hyperparathyroidism should be differeniated from other causes of hypercalcemia. |
| {|
| | Causes of hypercalcemia include: |
| ! colspan="3" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Factors influencing sensitivity of Tc-99m sestamibi scintigraphy}}
| | *Parathyroid related |
| |-
| | **Primary hyperparathyroidism |
| | colspan="2" style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Factors'''}}
| | ***Typical primary hyperparathyroidism |
| | style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|'''Sensitivity'''}}
| | ***Familial hypocalciuric hypercalcemia |
| |-
| | **Secondary hyperparathyroidim |
| | rowspan="4" style="background: #F0FFFF; text-align: center;" |'''Biochemical factors'''
| | **Tertiary hyperparathyroidism |
| | style="background: #DCDCDC;" |High serum calcium level<ref name="pmid12769210">{{cite journal| author=Parikshak M, Castillo ED, Conrad MF, Talpos GB| title=Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. | journal=Am Surg | year= 2003 | volume= 69 | issue= 5 | pages= 393-8; discussion 399 | pmid=12769210 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12769210 }} </ref>
| | *Non-parathyroid related |
| | style="background: #DCDCDC;" |Increased
| | **Malignancy |
| |-
| | ***Para-neoplastic syndrome: Parathyroid hormone related peptide |
| | style="background: #DCDCDC;" |High serum parathyroid hormone level<ref name="pmid12769210">{{cite journal| author=Parikshak M, Castillo ED, Conrad MF, Talpos GB| title=Impact of hypercalcemia and parathyroid hormone level on the sensitivity of preoperative sestamibi scanning for primary hyperparathyroidism. | journal=Am Surg | year= 2003 | volume= 69 | issue= 5 | pages= 393-8; discussion 399 | pmid=12769210 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12769210 }} </ref><ref name="pmid17053383">{{cite journal| author=Siegel A, Alvarado M, Barth RJ, Brady M, Lewis J| title=Parameters in the prediction of the sensitivity of parathyroid scanning. | journal=Clin Nucl Med | year= 2006 | volume= 31 | issue= 11 | pages= 679-82 | pmid=17053383 | doi=10.1097/01.rlu.0000242212.23936.a7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17053383 }} </ref>
| | ***Hypercalcemia due to bone destruction |
| | style="background: #DCDCDC;" |Increased
| | **Medication induced |
| |-
| | ***Thiazide diuretics |
| | style="background: #DCDCDC;" |Hypovitaminosis D <ref name="pmid18936353">{{cite journal| author=Kandil E, Tufaro AP, Carson KA, Lin F, Somervell H, Farrag T et al.| title=Correlation of plasma 25-hydroxyvitamin D levels with severity of primary hyperparathyroidism and likelihood of parathyroid adenoma localization on sestamibi scan. | journal=Arch Otolaryngol Head Neck Surg | year= 2008 | volume= 134 | issue= 10 | pages= 1071-5 | pmid=18936353 | doi=10.1001/archotol.134.10.1071 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18936353 }} </ref>
| | ***Lithium |
| (only in primary hyperparathyroidism)
| | **Nutritional |
| | style="background: #DCDCDC;" |Increased
| | ***Milk alkali syndrome |
| |-
| | ***Vitamin D toxicity |
| | style="background: #DCDCDC;" |Calcium channel blocker use<ref name="pmid15657576">{{cite journal| author=Friedman K, Somervell H, Patel P, Melton GB, Garrett-Mayer E, Dackiw AP et al.| title=Effect of calcium channel blockers on the sensitivity of preoperative 99mTc-MIBI SPECT for hyperparathyroidism. | journal=Surgery | year= 2004 | volume= 136 | issue= 6 | pages= 1199-204 | pmid=15657576 | doi=10.1016/j.surg.2004.06.047 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15657576 }} </ref>
| | **Granulomatous disease |
| (only in primary hyperparathyroidism)
| | ***Sarcoidosis |
| | style="background: #DCDCDC;" |Decreased
| | **Surgical |
| |-
| | ***Immobilization |
| | rowspan="2" style="background: #F0FFFF; text-align: center;" |'''Gross and architectural factors'''
| |
| | style="background: #DCDCDC;" |Size (Large)<ref name="pmid15967881">{{cite journal| author=Mehta NY, Ruda JM, Kapadia S, Boyer PJ, Hollenbeak CS, Stack BC| title=Relationship of technetium Tc 99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue. | journal=Arch Otolaryngol Head Neck Surg | year= 2005 | volume= 131 | issue= 6 | pages= 493-8 | pmid=15967881 | doi=10.1001/archotol.131.6.493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15967881 }} </ref><ref name="pmid10565772">{{cite journal| author=Takebayashi S, Hidai H, Chiba T, Takagi Y, Nagatani Y, Matsubara S| title=Hyperfunctional parathyroid glands with 99mTc-MIBI scan: semiquantitative analysis correlated with histologic findings. | journal=J Nucl Med | year= 1999 | volume= 40 | issue= 11 | pages= 1792-7 | pmid=10565772 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10565772 }} </ref>
| |
| | style="background: #DCDCDC;" |Increased
| |
| |-
| |
| | style="background: #DCDCDC;" |Multi-glandular disease<ref name="pmid14585407">{{cite journal| author=Haciyanli M, Lal G, Morita E, Duh QY, Kebebew E, Clark OH| title=Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. | journal=J Am Coll Surg | year= 2003 | volume= 197 | issue= 5 | pages= 739-46 | pmid=14585407 | doi=10.1016/S1072-7515(03)00676-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14585407 }} </ref>
| |
| | style="background: #DCDCDC;" |Decreased
| |
| |-
| |
| | style="background: #F0FFFF; text-align: center;" |'''Cytological factors'''
| |
| | style="background: #DCDCDC;" |Increased amount of cellular content<ref name="pmid15967881">{{cite journal| author=Mehta NY, Ruda JM, Kapadia S, Boyer PJ, Hollenbeak CS, Stack BC| title=Relationship of technetium Tc 99m sestamibi scans to histopathological features of hyperfunctioning parathyroid tissue. | journal=Arch Otolaryngol Head Neck Surg | year= 2005 | volume= 131 | issue= 6 | pages= 493-8 | pmid=15967881 | doi=10.1001/archotol.131.6.493 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15967881 }} </ref><ref name="pmid10565772">{{cite journal| author=Takebayashi S, Hidai H, Chiba T, Takagi Y, Nagatani Y, Matsubara S| title=Hyperfunctional parathyroid glands with 99mTc-MIBI scan: semiquantitative analysis correlated with histologic findings. | journal=J Nucl Med | year= 1999 | volume= 40 | issue= 11 | pages= 1792-7 | pmid=10565772 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10565772 }} </ref>
| |
| (Chief cells and oxyphil cells)
| |
| | style="background: #DCDCDC;" |Increased
| |
| |-
| |
| | style="background: #F0FFFF; text-align: center;" |'''Immunohistochemical factors'''
| |
| | style="background: #DCDCDC;" |Increased P-glycoprotien expression<ref name="pmid17929232">{{cite journal| author=Gupta Y, Ahmed R, Happerfield L, Pinder SE, Balan KK, Wishart GC| title=P-glycoprotein expression is associated with sestamibi washout in primary hyperparathyroidism. | journal=Br J Surg | year= 2007 | volume= 94 | issue= 12 | pages= 1491-5 | pmid=17929232 | doi=10.1002/bjs.5882 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17929232 }} </ref>
| |
| | style="background: #DCDCDC;" |Decreased
| |
| |-
| |
| | colspan="3" style="background: #F0FFFF;" |'''Note:''' P-glycoprotein (Pgp) is a plasma membrane protein encoded by mammalian multidrug resistance gene (MDRI). Many drugs that are lipophilic and cationic at physiological pH interact with P-gp. Sestamibi is a lipophilic cationic on physioligical pH. P-gp acts as ATP-dependent efflux pump and prevents accumulation of sestamibi in parathyroid tissue. So, the uptake of sestamibi into parathyroid adenoma cells depends on the activity of the P-gp<ref name="pmid8094997">{{cite journal| author=Piwnica-Worms D, Chiu ML, Budding M, Kronauge JF, Kramer RA, Croop JM| title=Functional imaging of multidrug-resistant P-glycoprotein with an organotechnetium complex. | journal=Cancer Res | year= 1993 | volume= 53 | issue= 5 | pages= 977-84 | pmid=8094997 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8094997 }} </ref>.
| |
| |}
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