Use of [18F]fluorocholine PET/CT in the detection of primary hyperparathyroidism in paediatrics: a case report

Objectives: The most common cause of primary hyperparathyroidism (PPH) in children is a parathyroid adenoma. Among this population, PPH exhibits higher levels of morbidity, severity and target organ involvement compared to adults. When there is suspicion of PPH, cervical ultrasound and Tc-99m-sestamibi SPECT/CT are the imaging test traditionally indicated. Among adults, the use of [F-18]fluorocholine PET/CT has shown a higher sensitivity than ultrasound and [Tc-99m]sestamibi SPECT/CT, leading to an expanding adoption in recent years. However, its role in paediatrics has not been clearly defined yet. Case presentation: The patient is an adolescent female aged 13 years presented with lithiasis. The analytical study revealed elevated PTH, hipovitaminosis D, hypercalcaemia and hypophosphataemia. Due to the suspicion of PPH, cervical ultrasound and Tc-99m-sestamibi SPECT/C were performed, failing to identify hyperfunctioning parathyroid glands. We proceeded to carry out a [F-18]fluorocholine PET/CT where a hypermetabolic nodular image was identified, compatible with a hyperfunctioning parathyroid adenoma. The patient underwent surgery, resulting in the normalisation of PTH levels. Pathological anatomy confirmed the presence of a parathyroid adenoma. Conclusions: In cases where conventional imaging tests yield negative results or discrepancies, we suggest the possibility of the use of [F-18]fluorocholine PET/CT for the detection of hyperfunctioning parathyroid adenomas.