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Sachiko-Tsukamoto Kawashima Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
Department of Diabetes, Endocrinology and Metabolism Tango Central Hospital, Kyoto, Japan

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Takeshi Usui Clinical Research Institute

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Yohei Ueda Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

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Maiko-Kakita Kobayashi Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

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Mika Tsuiki Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

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Kanako Tanase-Nakao Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

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Kazutaka Nanba Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

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Tetsuya Tagami Department of Endocrinology and Metabolism, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

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Mitsuhide Naruse Clinical Research Institute

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Yoshiki Watanabe Department of Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan

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Ryo Asato Department of Head and Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan

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Sumiko Kato Osaka Saiseikai Ibaraki Hospital, Osaka, Japan

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Akira Shimatsu Clinical Research Institute

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asymptomatic hypercalcemia. Routine preoperative diagnostic tools, such as ultrasonography (US) or 99m technetium-sestamibi (99mTc-MIBI) scans, cannot clearly distinguish between these entities (2) . We report a hypercalcemic patient with a cervical cystic

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Lara Ulrich General Surgery, Kingston Hospital, London, UK

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Graham Knee Pathology, Kingston Hospital, London, UK

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Colin Todd Radiology, Kingston Hospital, London, UK

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impossible to exclude a malignancy on imaging alone. In order to exclude the possibility of a parathyroid carcinoma and treat her hypercalcaemia, she was referred for elective surgery. Figure 2 Subtraction sestamibi nuclear medicine scan showing a

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Mauro Boronat Section of Endocrinology and Nutrition

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Juan J Cabrera Service of Pathology, Complejo Hospitalario Universitario Insular Materno-Infantil, Avenida Marítima del Sur, s/n. 35016 Las Palmas de Gran Canaria, Spain

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Carmen Perera Service of Nuclear Medicine, Hospital General de Gran Canaria Dr Negrín. Plaza Barranco de la Ballena, s/n. 35012 Las Palmas de Gran Canaria, Spain

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Concepción Isla Service of Nuclear Medicine, Complejo Hospitalario Universitario Insular Materno-Infantil, Avenida Marítima del Sur, s/n. 35016 Las Palmas de Gran Canaria, Spain

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Francisco J Nóvoa Section of Endocrinology and Nutrition

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-abdominal CT scan were negative. A 99m Tc SestaMIBI WBS disclosed a well-delimited focal uptake in the distal region of the right femur ( Fig. 1 ). A FDG-PET/CT study performed after rhTSH stimulation showed lytic resorption in the left iliac crest, just above

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Mona Abouzaid Department of Diabetes and Endocrinology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

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Ahmed Al-Sharefi Department of Diabetes and Endocrinology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

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Satish Artham Department of Diabetes and Endocrinology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
Department of Endocrinology and Diabetes, North Tees and Hartlepool Hospitals NHS Foundation Trust, Hartlepool, UK

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Ibrahim Masri Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

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Ajay Kotagiri Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

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Ashwin Joshi Department of Diabetes and Endocrinology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK

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ultrasonography, high-resolution computed tomography (CT) and technetium sestamibi scan of the neck. An ultrasound of the abdomen showed no nephrocalcinosis but a bone densitometry scan confirmed a diagnosis of osteoporosis which was mostly affecting the distal

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Thien Vinh Luong Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark

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Lars Rejnmark Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

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Anne Kirstine Arveschoug Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark

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Peter Iversen Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital, Aarhus, Denmark

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Lars Rolighed Department of Otorhinolaryngology, Aarhus University Hospital, Aarhus, Denmark

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, depression, and tiredness. Treatment of primary HPT in MEN1 patients usually involves preoperative localization of enlarged PGs, typically with ultrasonography (US) and a 99m Tc-sestamibi scintigraphy (MIBI) often combined with a single photon emission and a

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K Nadarasa Department of Endocrinology, St Bartholomew's Hospital, London, UK

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M Bailey Department of Endocrinology, St Bartholomew's Hospital, London, UK

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H Chahal Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, London, UK

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O Raja Department of Endocrinology, St Bartholomew's Hospital, London, UK

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R Bhat Department of Neonatology, King's College Hospital, London, UK

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C Gayle Department of Diabetes, King's College Hospital, London, UK

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A B Grossman Department of Endocrinology, St Bartholomew's Hospital, London, UK

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M R Druce Department of Endocrinology, St Bartholomew's Hospital, London, UK

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ultrasound scan of the parathyroid glands and Technetium-99m sestamibi imaging confirmed an abnormal right upper parathyroid gland. The patient underwent a parathyroidectomy and the histology revealed a 15×12×18 mm parathyroid carcinoma extending to the

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Caroline Bachmeier Endocrinology Department, Townsville Hospital, Townsville, Queensland, Australia

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Chirag Patel Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia

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Peter Kanowski Clinical Pathology/Histopathology, Sullivan Nicolaides Pathology, Townsville, Queensland, Australia

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Kunwarjit Sangla Endocrinology Department, Townsville Hospital, Townsville, Queensland, Australia
James Cook University, Townsville, Queensland, Australia

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.06–0.45). 25-Hydroxycholecalciferol was 67 nmol/L (50–150 nmol/L). A parathyroid scan including pertechnate and Tc99m Sestamibi with early and delayed SPECT/CT of neck and mediastinum showed a solitary parathyroid adenoma in the lower pole of the left lobe of

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Peter Novodvorsky Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK

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Ziad Hussein Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

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Muhammad Fahad Arshad Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

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Ahmed Iqbal Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

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Malee Fernando Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

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Alia Munir Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK

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Sabapathy P Balasubramanian Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

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of conditions, the most common being solitary thyroid adenoma, followed by benign and malignant lesions of the neck, breast or lung, thymic lesions or reactive lymph nodes ( 13 ). Although the sensitivity of the 99m Tc sestamibi scan is high in

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Aisling McCarthy University Hospital Galway, Galway, Ireland

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Sophie Howarth Department of Diabetes and Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, UK

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Serena Khoo Department of Diabetes and Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, UK

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Julia Hale Department of Diabetes and Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, UK

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Sue Oddy Department of Clinical Biochemistry, Cambridge University NHS Foundation Trust, Cambridge, UK

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David Halsall Department of Clinical Biochemistry, Cambridge University NHS Foundation Trust, Cambridge, UK

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Brian Fish Department of Head and Neck Surgery, Cambridge University NHS Foundation Trust, Cambridge, UK

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Sashi Mariathasan Department of Diabetes and Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, UK

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Katrina Andrews East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK

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Samson O Oyibo Department of Diabetes and Endocrinology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK

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Manjula Samyraju Department of Obstetrics and Gynecology, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK

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Katarzyna Gajewska-Knapik Department of Obstetrics and Gynecology, Cambridge University NHS Foundation Trust, Cambridge, UK

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Soo-Mi Park East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK

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Diana Wood Department of Diabetes and Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, UK

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Carla Moran Department of Diabetes and Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, UK

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Ruth T Casey Department of Diabetes and Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, UK
Department of Medical Genetics, Cambridge University, Cambridge, UK

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is limited in pregnancy as computed tomography and the gold standard 99mTc Sestamibi scan are contraindicated because of the radiation risk to the foetus, and therefore, ultrasound remains the only suitable radiological imaging modality in pregnancy

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Deep Dutta Departments of Endocrinology and Metabolism

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Chitra Selvan Departments of Endocrinology and Metabolism

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Manoj Kumar Departments of Endocrinology and Metabolism

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Saumik Datta Departments of Endocrinology and Metabolism

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Ram Narayan Das Pathology, IPGMER and SSKM Hospital, Room-9A, 4th Floor Ronald Ross Building, 244 AJC Bose Road, Calcutta 700020, India

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Sujoy Ghosh Departments of Endocrinology and Metabolism

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Satinath Mukhopadhyay Departments of Endocrinology and Metabolism

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Subhankar Chowdhury Departments of Endocrinology and Metabolism

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thyroid cyst. Six milliliters of serous fluid were aspirated, iPTH measurement from which revealed a level of 3480 pg/ml. Figure 2 Tc 99m sestamibi scan did not reveal any functional parathyroid adenoma. Poor radiotracer uptake in the lower pole and

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