Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2015) 37 EP291 | DOI: 10.1530/endoabs.37.EP291

ECE2015 Eposter Presentations Calcium and Vitamin D metabolism (96 abstracts)

The diagnostic value of parathyroid hormone washout after fine-needle aspiration in patients with primary hyperparathyroidism

Fotini Adamidou 1 , Panagiotis Anagnostis 1 , Vasileios Champidis 1 , Simoni Katergari 1 , Georgios Zacharioudakis 2 & Marina Kita 1


1Department of Endocrinology, Hippokration Hospital of Thessaloniki, Thessaloniki, Greece; 2Fifth Department of Surgery, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.


Introduction: Commonly used pre-operative methods (ultrasonography and sestamibi scan) to localize the culprit parathyroid gland(s) in patients with primary hyperparathyroidism (PHPT), frequently yield false positive or false negative results. Parathyroid hormone (PTH) washout after fine-needle aspiration (FNA) may allow for a targeted surgical approach. The aim of this study was to test the diagnostic value of preoperative PTH washout after FNA in PHPT patients.

Methods/design: Retrospective study conducted in a tertiary centre. Ultrasound-guided FNA was performed if a structure compatible with a parathyroid adenoma was found on cervical ultrasound. A PTH washout cut-off value was considered diagnostic if it was higher than the concomitant serum PTH value.

Results: Twenty-nine patients (2 (6.8%) males, mean age 58.6±9.1 years) were included. Mean pre-operative serum PTH levels were 194.2±176.8 pg/ml (normal: 10–53), while serum calcium and 25-hydroxy-vitamin D levels were 11.5±1.4 mg/dl (normal: 8.8–10.6) and 24.1±20.5 ng/ml (deficiency: <20 ng/ml) respectively. Post-operative serum PTH and calcium levels were 45.9±26.3 pg/ml and 9.04±0.7 mg/dl respectively. A single adenoma was identified in 26 (89.7%) patients and a double adenoma in 1 (3.4%). Two (6.9%) patients were harbouring an ectopic parathyroid adenoma (upper mediastinal and intrathyroid). Twenty-four patients (82.7%) had elevated PTH washout concentrations (mean values: 2009.5±1417.6 pg/ml). True positive and false negative results were 24 and 4 respectively. The sensitivity, specificity and positive predictive value (PPV) were 85.71, 100, and 100% respectively. Interestingly, in ten out of 12 patients with a negative sestamibi scan, the PTH washout yielded a truly positive result.

Conclusions: Elevated PTH washout concentrations after ultrasound-guided FNA is an highly accurate diagnostic tool in identifying parathyroid adenomas and guiding parathyroid surgery.

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