Gamma-probe localization of a parathyroid adenoma in the reoperative neck

Preoperative localization of parathyroid adenomas in patients with hyperpar athyroidism currently relies on a combination of computed tomography, magne tic resonance imaging, ultrasound, Tc-99m-sestamibi scintigraphy, and venou s sampling of parathyroid hormone. No procedure is universally reliable, ho wever, and in reoperation for missed parathyroid adenomas, development of a n optimal preoperative localization strategy becomes especially problematic . We report the case of a patient with hyperparathyroidism who required reo peration for a missed parathyroid adenoma despite preoperative localization with Tc-99m-sestamibi scintigraphy. Tc-99m-sestamibi scintigraphy was done 2.5 hours before reoperation. On reoperation, a gamma-detecting probe (C-T rack; Care Wise Medical Corporation, Morgan Hill, CA) introduced through a right neck incision was used to localize a 4-cm adenoma within 45 minutes. No significant radiation hazard existed, and no special handing of the spec imen was required. The patient's hyperparathyroidism resolved within 24 hou rs postoperatively. Therefore, this intraoperative technique may prove to b e a useful adjunct to preoperative localization studies of parathyroid aden omas, particularly in patients requiring reoperation for persistent postsur gical hyperparathyroidism. Copyright (C) 2000 by W.B. Saunders Company.