Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2016) 41 S21.3 | DOI: 10.1530/endoabs.41.S21.3

ECE2016 Symposia An update on hyperparathyroidism (3 abstracts)

What is new in imaging and surgery for hyperparathyroidism

Marko Hocevar



During last few decades primary hyperparathyroidism (PHP) evolved from the disease of ‘bones, moans, stones and groans’ to a disorder that is most commonly asymptomatic and incidentally diagnosed with increasing biochemical screening. At the same time different localization studies of the abnormal parathyroid gland(s) emerged. Because PHP is caused in more than 85% of patients with a single gland adenoma which can be reliably localized preoperatively, there has been a major paradigm shift in the management of PHT. The traditional approach to parathyroid surgery, consisted of bilateral neck exploration with the cure rates around 95%, was replaced by a more focused minimally invasive approach based on pre-operative localization and intraoperative parathyroid hormone testing (ioPTH). Minimally invasive approach is critically dependent on the preoperative localization studies and their imperfection represents its major limitation.

Ultrasound is the most frequently used anatomic imaging modality with the lowest cost and reported sensitivity of 70% to 100% for detecting enlarged parathyroid glands. It is highly operator-dependent and in the presence of thyroid gland abnormalities its sensitivity decreases.

Sestamibi scanning is the most frequently used functional imaging modality with reported sensitivity of 54–100% for identifying single gland adenoma. Addition of single photon emission computed tomography can further improve the sensitivity.

Recently our group reported a study of 18F-fluorocholine PET/CT as a promising, effective imaging method for localization of hyperfunctioning parathyroid tissue with higher sensitivity than sestamibi scanning.

Use of ioPTH is a highly effective intraoperative adjunct telling a surgeon when to conclude the operation during focused minimally invasive parathyroidectomy. However, the benefit of ioPTH may be marginal in the presence of a highly sensitive preoperative localization study and patients with a single adenoma can safely undergo a focused parathyroidectomy without ioPTH testing.

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