Primary hyperparathyroidism: adenoma or hyperplasia

Introduction: primary hyperparathyroidism (PH) is a symptomatic or asymptomaticclinical entity, characterized by the autonomous production of parathyroid hormone (PTH). Its classical presentation exhibits an increase of the serum calcium andparathyroid hormone levels. Parathyroid scintigrafy, among other imaging modalities,is frequently used to detect the hyperfunctioning glands.Clinical case: number 1. Female, 69 years old, asymptomatic, hypertension of recentonset, osteopenia, increased intact PTHi level and serum calcium concentration, andlow phosphate level, multinodular goiter (ultrasound), and focal increased uptake inthe inferolateral aspect of thyroid right lobe (parathyroid scintigraphy) consistent withparathyroid adenoma, confirmed by surgery and histopathology examination. Number2. Female, 69 years old, with history of chronic hypertension, nephrolithiasis andpartial thyroidectomy, actually with chronic diarrhea and headaches, erosive chronicduodenitis (endoscopy), increase of PTHi and serum calcium levels, changes in contrastneck CT scan and US consistent with thyroidectomy, and parathyroid scintigraphy withthree areas of focal increased isonitrile uptake consistent with parathyroid hyperplasia,confirmed by surgery and histopathologic findings.Conclusion: the parathyroid Scintigraphy (planar and Spect, double phase and doubletracer) done in combination, have good sensibility, specificity and diagnostic accuracyof parathyroid adenomas and hyperplasia, improving surgical procedures, with minimalincision or invasion, ad quality of life of hyperparathyroidism patients. Rev.cienc.biomed. 2012;3(2):350-354RESUMEN:Introducción: el hiperparatiroidismo primario (HP) es una entidad clínica sintomáticao asintomática, caracterizada por la producción autónoma de parathormona (PTH).Se presenta elevación del calcio sérico y de la parathormona (PTH), aunque estaúltima puede permanecer dentro en los rangos normales altos. La gammagrafía deparatiroides es uno de los estudios imagenológicos que se utiliza para localizar lasglándulas hiperfuncionantes.Casos clínicos: número 1. Mujer de 69 a os, asintomática, con hipertensión arterialde reciente comienzo y osteopenia. PTHi y calcio sérico elevados, fósforo disminuido.Ecografía de tiroides: bocio multinodular. Gammagrafía de paratiroides: hipercaptaciónfocal del trazador, inferior y lateralmente al lóbulo derecho de la tiroides, compatible conadenoma paratiroideo. Realizada cirugía para resección. Diagnóstico confirmado porhallazgos quirúrgicos y de anatomía patológica. Número 2. Mujer de 69 a os, hipertensióncró