A clinical case of combined differentiated thyroid cancer and primary hyperparathyroidism: the complexity of topical differential diagnosis

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Abstract


In recent years, the understanding of the epidemiology, symptoms and strategies for managing patients with hyperparathyroidism has changed significantly. The most common cases in clinical practice are of sporadic primary hyperparathyroidism, which today ranks third in prevalence among endocrine diseases (the frequency of occurrence in the adult population is, on average, 1–2%). In primary hyperparathyroidism, solitary parathyroid adenoma is detected in up to 85% of all cases. The only treatment is radical surgical removal of pathologically altered parathyroid tissue. Early diagnosis and treatment of hyperparathyroidism makes it possible to avoid severe lesions of the skeletal bones and visceral organs. A diagnostically challenging clinical case of a combined onco-endocrine pathology in a 70-year-old patient is presented. The main difficulties in the initial diagnosis were associated with the absence of pathognomonic symptoms of the disease, which was often completely asymptomatic. The most urgent problem appears to be the topical diagnosis of pathologically altered parathyroid glands. Therefore, there is a need to develop an algorithm for the combining and sequential use of existing medical imaging methods.


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About the authors

Konstantin Yu. Slashchuk

Endocrinology Research Centre

Author for correspondence.
Email: slashuk911@gmail.com
ORCID iD: 0000-0002-3220-2438
SPIN-code: 3079-8033
ResearcherId: P-4518-2015

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD

Mikhail V. Degtyarev

Endocrinology Research Centre

Email: germed@mail.ru
ORCID iD: 0000-0001-5652-2607
SPIN-code: 7725-7831

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD

Sergey S. Serzhenko

Endocrinology Research Centre

Email: vv1ld@yandex.com
ORCID iD: 0000-0003-2326-1396
SPIN-code: 4713-8986

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD

Pavel O. Rumyantsev

Endocrinology Research Centre

Email: pavelrum@gmail.com
ORCID iD: 0000-0002-7721-634X
SPIN-code: 7085-7976
Scopus Author ID: 110759

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Marina S. Sheremeta

Endocrinology Research Centre

Email: marina888@yandex.ru
ORCID iD: 0000-0003-3785-0335
SPIN-code: 7845-2194

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Valentina S. Yasuchenia

Endocrinology Research Centre

Email: loveissiberia@gmail.com
ORCID iD: 0000-0002-7624-7953
SPIN-code: 3810-5848

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD

Alexey A. Trukhin

Endocrinology Research Centre

Email: alexey.trukhin12@gmail.com
ORCID iD: 0000-0001-5592-4727

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

Yaroslav I. Sirota

Endocrinology Research Centre

Email: yaroslawsirota@gmail.com
ORCID iD: 0000-0002-0613-9543

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

Olga D. Baranova

Endocrinology Research Centre

Email: olga.dm1091@gmail.com
ORCID iD: 0000-0001-7548-9056
SPIN-code: 1285-0654

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD

Petr A. Nikiforovich

Endocrinology Research Centre

Email: nikiforovichdoc@gmail.com
ORCID iD: 0000-0003-4031-5050
SPIN-code: 7305-5232
Scopus Author ID: 978547

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD

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Supplementary files

Supplementary Files Action
1.
Fig. 1. The upper row - planar scintigraphy 15 and 90 minutes after the introduction of radiopharmaceutical; bottom row - SPECT / CT after 90 min; The arrow (→) marks the zones of intense radiopharmaceutical accumulation in the projection of the right lower thyroid and the node in the lower pole of the left thyroid lobe.

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2.
Fig. 2. The diagnostic search algorithm (scheme).

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Copyright (c) 2019 Slashchuk K.Y., Degtyarev M.V., Serzhenko S.S., Rumyantsev P.O., Sheremeta M.S., Yasuchenia V.S., Trukhin A.A., Sirota Y.I., Baranova O.D., Nikiforovich P.A.

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