Clinical Presentation

Two years ago, a 30-year-old gravida 1, para 0 woman presented with severely labile hypertension during pregnancy, which continued into the postpartum period. Now she presents with elevated calcium, parathyroid hormone, and calcitonin.

Fig. 96.1

Fig. 96.2

Fig. 96.3

Technique

¹¹¹In-Pentetreotide Scan (also see ^99mTc-Sestamibi Scan)

• If possible, withhold nonradiolabeled octreotide before the scan; withhold 24 hours for short- acting octreotide and 3 to 4 weeks for long-acting formulations.

• The patient should be well hydrated to enhance renal clearance.

• If the patient has an insulinoma, a glucose infusion should be available to treat paradoxical hypoglycemia.

• 6 mCi (222 MBq)

• Slow intravenous injection over 1 minute

• Medium-energy collimator

• 172- and 247-keV photopeaks, 20% window

• Planar: anterior and posterior views from head to pelvis at 4 and 24 hours

• SPECT: abdomen and pelvis at 4 hours

• SPECT: chest, abdomen, and pelvis at 24 hours

• Additional images can be obtained at 48 hours if there is uncertainty whether abdominal activity represents pathologic or physiologic uptake.

^99mTc-Sestamibi Scan

• None

• 30 mCi (1110 MBq)

• Intravenous injection

• Low-energy, high-resolution collimator

• 140-keV photopeak, 20% window