[Samitin]

For diagnosis confirmation, 99mTc-sestamibi SPECT/CT seems to be an advantageous test. Another possibility is to perform 99mTc-sestamibi followed by thoracic CT or MRI.

Persistent primary hyperparathyroidism: an uncommon location for an ectopic gland – Case report and review - Arq Bras Endocrinol Metab. 2012;56/6 ([Ссылки доступны только зарегистрированным пользователям ]).


А тут (Visualization of Ectopic Parathyroid Adenomas - n engl j med 369;21, [Ссылки доступны только зарегистрированным пользователям ]) пишут, что ПЭТ-МРТ - тоже неплохо:

Taken together, the exact image fusion, the excellent soft-tissue contrast, and the lower radiation exposure of simultaneous PET-MRI suggest that this new form of medical imaging might be superior to PET-CT for the diagnostic localization of an ectopic parathyroid adenoma.

И еще пара случаев эктопии:

A Case of Primary Hyperparathyroidism due to Ectopic Parathyroid Adenoma in the Thymus, Accompanied With Vitamin D Deficiency ([Ссылки доступны только зарегистрированным пользователям ]);

A patient with persistent primary hyperparathyroidism due to a second ectopic adenoma - [Ссылки доступны только зарегистрированным пользователям ].

Про восполнение дефицита D не так давно здесь говорили, но тема сейчас почему-то не попадается... Впрочем, вот что написано в [Ссылки доступны только зарегистрированным пользователям ] по состоянию на 2011 год (Clinical Significance of Vitamin D Deficiency in Primary Hyperparathyroidism, and Safety of Vitamin D Therapy - South Med J. 2011;104(1):29-33.):

Vitamin D deficiency occurs more frequently in patients with primary hyperparathyroidism (PHPT) compared with the general population, and is usually associated with an aggravated form of the disease. Current guidelines recommend measurement of serum levels of 25-hydroxy vitamin D (25-OHD) in all patients with PHPT, and their repletion if the levels are less than 50 mmol/L (20 ng/mL). Limited data suggest that vitamin D treatment is generally safe in subjects with mild PHPT and coexisting vitamin D deficiency. Adverse effects include hypercalcuria and, less commonly, exacerbation of hypercalcemia. Well-designed trials are needed to evaluate the safety of vitamin D replacement therapy in a wide spectrum of patients with concomitant PHPT and vitamin D deficiency. These trials should address the impact of such therapy on the complications and course of PHPT.

Последний уровень кальция 2,89 ммоль/л как раз укладывается в 12 мг/дл...