Incidental Detection of Parathyroid Adenoma on Somatostatin Receptor PET/CT and Incremental Role of 18F-Fluorocholine PET/CT in MEN1 Syndrome

Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by combined occurrence of tumors of endocrine glands including the parathyroid, the pancreatic islet cells, and the anterior pituitary gland. Parathyroid involvement is the most common manifestation and usually the first clinical involvement in MEN1 syndrome, followed by gastroentero-pancreatic neuroendocrine tumors (NETs). Here we present a case where the patient initially presented with metastatic gastric NET and a single parathyroid adenoma was detected incidentally on (68)Ga-DOTANOC PET/CT done as part of post (177)Lu-DOTATATE therapy (PRRT) follow-up. Further (18)F-fluorocholine PET/CT showed four adenomas for which the patient subsequently underwent subtotal parathyroidectomy.