A 39-year-old woman presented with complaints of bone pain and intestinal cramps. She was found to have elevated serum calcium and elevated parathormone levels. Sestimibi scan showed showed increased uptake in the left lower neck. A diagnosis of probable parathyroid adenoma was made, and the patient was taken to the operating room for gamma probe-guided, minimally invasive parathyroidectomy with immediate intraoperative parathormone assay. Parathormone assay in the holding area was 81pg/cc.
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One hour before the start of the procedure, 15 millicuries of sestimibi in cardiolipin was injected. Within 30 minutes the tracer localizes in parathyroid tissue. A baseline gamma probe reading was taken, which was automatically subtracted from all subsequent readings. The video shows localization of the hot spot.
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