Thor Halfdanarson, Professor of Oncology at Mayo Clinic School of Medicine, shared on X:
“Lesson of the day
A patient with MEN1 and past hyperparathyroidism, status post 4 gland parathyroidectomy with left forearm parathyroid autotransplantation comes in for a routine MEN1 exam. Previously normocalcemic with normal PTH.
Now there is unexplained substantial elevation of PTH but calcium is normal and no concerning symptoms.
What is going on?
As it happens, the labs were drawn from the left arm, downstream from (proximal to) the autotransplanted parathyroid in the left forearm. Repeat PTH from the other arm completely normal as before. I have been seeing patients with MEN1 for 20 years and I was not aware of this… But I have colleagues like the incomparable Dr. William Young who are always teaching me.
Did you know that liver metastases from insulinoma can have a surrounding area of fatty infiltration/focal steatosis around the metastases?
This I did know but perhaps others may not. Here are a couple of images from this months NET clinic. The first image is early phase contrast and the 2nd image is delayed gadoxetate (Eovist) sequence. Clinicians should always look at the imaging studies they order and have a basic understanding of them.
No better place to learn than going to tumor board.”
Other articles featuring Thor Halfdanarson on OncoDaily.