Use of [18F]fluorocholine PET/CT in the detection of primary hyperparathyroidism in paediatrics: a case report
-
Helena Martínez Sánchez
,
Francisca Moreno Macián
Abstract
Objectives
The most common cause of primary hyperparathyroidism (PPH) in children is a parathyroid adenoma. Among this population, PPH exhibits higher levels of morbidity, severity and target organ involvement compared to adults. When there is suspicion of PPH, cervical ultrasound and 99mTc-sestamibi SPECT/CT are the imaging test traditionally indicated. Among adults, the use of [18F]fluorocholine PET/CT has shown a higher sensitivity than ultrasound and [99mTc]sestamibi SPECT/CT, leading to an expanding adoption in recent years. However, its role in paediatrics has not been clearly defined yet.
Case presentation
The patient is an adolescent female aged 13 years presented with lithiasis. The analytical study revealed elevated PTH, hipovitaminosis D, hypercalcaemia and hypophosphataemia. Due to the suspicion of PPH, cervical ultrasound and 99mTc-sestamibi SPECT/C were performed, failing to identify hyperfunctioning parathyroid glands. We proceeded to carry out a [18F]fluorocholine PET/CT where a hypermetabolic nodular image was identified, compatible with a hyperfunctioning parathyroid adenoma. The patient underwent surgery, resulting in the normalisation of PTH levels. Pathological anatomy confirmed the presence of a parathyroid adenoma.
Conclusions
In cases where conventional imaging tests yield negative results or discrepancies, we suggest the possibility of the use of [18F]fluorocholine PET/CT for the detection of hyperfunctioning parathyroid adenomas.
-
Research ethics: The local Institutional Review Board deemed the study exempt from review.
-
Informed consent: Informed consent was obtained from all individuals included in this study.
-
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
-
Competing interests: Authors state no conflict of interest.
-
Research funding: None declared.
-
Data availability: Not applicable.
References
1. Khalatbari, H, Cheeney, S, Manning, S, Parisi, M. Pediatric hyperparathyroidism: review and imaging update. Pediatr Radiol 2021;51:1106–20. https://doi.org/10.1007/s00247-021-05050-7.Search in Google Scholar PubMed
2. Kollars, J, Zarroug, AE, Heerden, VJ, Lteif, A, Stavlo, P, Suarez, L, et al.. Primary hyperparathyroidism in pediatric patients. Pediatrics 2005;115:974–80. https://doi.org/10.1542/peds.2004-0804.Search in Google Scholar PubMed
3. Maali, BN, Wassim, E, Dahmane, H, mahdi, A, Ali, S, Hatem, H. Primary hyperparathyroidism due to ectopic intrathymic parathyroid adenoma in a child: a case report. J Endocrinol 2021;5. https://doi.org/10.23880/oaje-16000159.Search in Google Scholar
4. Guerrero, J, González, I, Barreda, A, Carcavilla, A, Itza, N, Mora, C, et al.. Manual of diagnosis and therapeutics in pediatric endocrinology. Madrid: Ergón; 2020.Search in Google Scholar
5. McKenna, K, Dunbar, N, Parham, K. Why is primary hyperparathyroidism more severe in children? Med Hypotheses 2021;147:110482. https://doi.org/10.1016/j.mehy.2020.110482.Search in Google Scholar PubMed
6. Zivaljevic, V, Jovanovic, M, Diklic, A, Zdravkovic, V, Djordjevic, M, Paunovic, I. Differences in primary hyperparathyroidism characteristics between children and adolescents. J Pediatr Surg 2020;55:1660–2. https://doi.org/10.1016/j.jpedsurg.2019.09.023.Search in Google Scholar PubMed
7. Toribio, I, Gardía, M, Sánchez, B, Torrico, P. Surgical management of primary hyperparathyroidism with negative presurgical localization tests. Rev ORL 2022;13:171–9.Search in Google Scholar
8. Boudousq, V, Guignard, N, Gilly, O, Chambert, B, Mamou, A, Moranne, O, et al.. Diagnostic performance of cervical ultrasound, 99mTc-sestamibi scintigraphy, and contrast-enhanced 18F-fluorocholine PET in primary hyperparathyroidism. J Nucl Med 2022;63:1081–6. https://doi.org/10.2967/jnumed.121.261900.Search in Google Scholar PubMed
9. Park, H, Hong, N, Jeong, J, Yun, M, Rhee, Y. Update on preoperative parathyroid localization in primary hyperparathyroidism. Endocrinol Metab 2022;37:744–55. https://doi.org/10.3803/enm.2022.1589.Search in Google Scholar
10. Boccalate, L, Higuera, F, Gómez, NL, de la Torre, AY, Mazzaro, EL, Galich, AM, et al.. Usefullness of 18-Fluorocholine positron emission tomography-computed tomography in locating lesions of hyperparathyroidism: a systematic review. JAMA Otolaryngol Head Neck Surg 2019;145:743–50.10.1001/jamaoto.2019.0574Search in Google Scholar PubMed
11. Cuderman, A, Senica, K, Rep, S, Hocevar, M, Kocjan, T, Jensterle, M, et al.. 18F-Fluorocholine PET/CT in primary hyperparathyroidism: superior diagnostic performance to conventional scintigraphic imaging for localization of hyperfunctioning parathyroid glands. J Nucl Med 2020;61:577–83. https://doi.org/10.2967/jnumed.119.229914.Search in Google Scholar PubMed
12. Boccalate, L, Gómez, N, Musumeci, M, Galich, A, Collaud, C, Figari, M. 18F-choline PET/4D CT in hyperparathyroidism: correlation between biochemical data and study parameters. Rev Esp Med Nucl 2020;39:273–8. https://doi.org/10.1016/j.remnie.2020.07.003.Search in Google Scholar
13. Treglia, G, Rizzo, A, Piccardo, A. Expanding the clinical indications of [18F]fuorocholine PET/CT in primary hyperparathyroidism: the evidence cannot be evaded. Eur J Nucl Med Mol Imag 2023. https://doi.org/10.1007/s00259-023-06573-x.Search in Google Scholar PubMed
14. Ballester, E, Pérez, JI, López, DA, Galán, C, Pareja, E, Clos, M, et al.. Identification of occult adenomas in primary hyperparathyroidism with 18 fluorocholine PET/CT. Cir Esp 2020;98:395–402. https://doi.org/10.1016/j.ciresp.2020.01.003.Search in Google Scholar PubMed
© 2024 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Original Articles
- Incidences of newly diagnosed childhood diabetes and onset severity: a multicenter regional study in Thailand over two decades and during the COVID-19 pandemic
- Exploring ketoacidosis frequency and risk factors in childhood-onset type 1 diabetes: an 8-year retrospective study (2011–2018) at a tertiary paediatric hospital in Tripoli, Libya
- Automated insulin delivery in children with type 1 diabetes during physical activity: a meta-analysis
- Association between maternal and cord blood thyroid hormones, and urine iodine concentration with fetal growth
- Post hoc subgroup analysis of Asian children with paediatric GHD from the global phase 3 efficacy and safety study of once-weekly somatrogon vs. once-daily somatropin
- Familial dysalbuminemic hyperthyroxinemia (FDH) due to Arg242 His variant in ALB gene in Turkish children
- A novel useful marker in the early discrimination of transient hyperthyrotropinemia/hypothyroxinemia and congenital hypothyroidism in preterm infants: thyroid-stimulating hormone/free thyroxine ratio
- Comprehensive analyses of phenylalanine hydroxylase variants and phenotypic characteristics of patients in the eastern region of Türkiye
- Relationship between urinary sodium excretion and bone mineral density in pediatrics: population-based study from KNHANES V 2010–2011
- Trajectory of the body mass index of children and adolescents attending a reference mental health center
- Case Reports
- Prenatal presentation of a hyperfunctioning thyroid nodule
- A very rare presentation of mitochondrial elongation factor Tu deficiency-TUFM mutation and literature review
- Identification of a novel homozygous NR5A1 variant in a patient with a 46,XY disorders of sex development
- Use of [18F]fluorocholine PET/CT in the detection of primary hyperparathyroidism in paediatrics: a case report
Articles in the same Issue
- Frontmatter
- Original Articles
- Incidences of newly diagnosed childhood diabetes and onset severity: a multicenter regional study in Thailand over two decades and during the COVID-19 pandemic
- Exploring ketoacidosis frequency and risk factors in childhood-onset type 1 diabetes: an 8-year retrospective study (2011–2018) at a tertiary paediatric hospital in Tripoli, Libya
- Automated insulin delivery in children with type 1 diabetes during physical activity: a meta-analysis
- Association between maternal and cord blood thyroid hormones, and urine iodine concentration with fetal growth
- Post hoc subgroup analysis of Asian children with paediatric GHD from the global phase 3 efficacy and safety study of once-weekly somatrogon vs. once-daily somatropin
- Familial dysalbuminemic hyperthyroxinemia (FDH) due to Arg242 His variant in ALB gene in Turkish children
- A novel useful marker in the early discrimination of transient hyperthyrotropinemia/hypothyroxinemia and congenital hypothyroidism in preterm infants: thyroid-stimulating hormone/free thyroxine ratio
- Comprehensive analyses of phenylalanine hydroxylase variants and phenotypic characteristics of patients in the eastern region of Türkiye
- Relationship between urinary sodium excretion and bone mineral density in pediatrics: population-based study from KNHANES V 2010–2011
- Trajectory of the body mass index of children and adolescents attending a reference mental health center
- Case Reports
- Prenatal presentation of a hyperfunctioning thyroid nodule
- A very rare presentation of mitochondrial elongation factor Tu deficiency-TUFM mutation and literature review
- Identification of a novel homozygous NR5A1 variant in a patient with a 46,XY disorders of sex development
- Use of [18F]fluorocholine PET/CT in the detection of primary hyperparathyroidism in paediatrics: a case report
