Beyond Parathyroid Localization: Incidental Detection of Multiple Endocrine Lesions on Ga-68 Trivehexin PET/CT

Abstract A 67-year-old woman presented with recurrent pancreatitis and biochemical evidence of primary hyperparathyroidism, including elevated parathyroid hormone, hypercalcemia, and low vitamin D levels. Neck ultrasonography and technetium-99m sestamibi single-photon emission computed tomography/computed tomography (CT) concordantly localized a left inferior parathyroid lesion. Gallium-68 (Ga-68) Trivehexin positron emission tomography (PET)/CT was performed as an exploratory molecular imaging modality and demonstrated intense tracer uptake corresponding to the suspected adenoma, which was subsequently confirmed on histopathology following focused left inferior parathyroidectomy. In addition, whole-body imaging revealed multiple incidental endocrine lesions, including a pituitary microadenoma (corroborated on magnetic resonance imaging, pituitary protocol), a right parotid adenoma (confirmed on histopathology as pleomorphic adenoma), and a lesion in the submental region, clinically suggestive of lingual thyroid without functional confirmation. There was no clinical, biochemical, or scan evidence suggestive of a syndromic association such as multiple endocrine neoplasia. This case highlights the potential complementary role of Ga-68 Trivehexin PET/CT in providing whole-body molecular imaging and identifying additional incidental findings beyond conventional localization modalities, which may warrant further evaluation in selected cases.