ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 50 P057 | DOI: 10.1530/endoabs.50.P057

Imaging in primary hyperparathyroidism; does it affect our referral pathways for surgery? Results of an audit

Anastasia Dede1, Daniel Morganstein1, Kevin Shotliff1, Veronica Greener1, James Smellie2, Annelies Maenhout3 & Alison Wren1

1Department of Endocrinology and Diabetes, Chelsea and Westminster Hospital, London, UK; 2Department of Endocrine Surgery, Chelsea and Westminster Hospital, London, UK; 3Department of Nuclear Medicine, Chelsea and Westminster Hospital, London, UK.

Introduction: The 4th International Workshop on asymptomatic primary hyperparathyroidism (PHPT) has set criteria for surgical intervention and suggests that a percentage of patients can be managed conservatively. Imaging is indicated only pre-operatively to determine the optimal surgical approach.

Patients and methods: We completed an audit on the use of Sestamibi, clinical and biochemical data in patients with PHPT.

Results: 117 consecutive patients undergoing a Sestamibi scan over 2.5 years were identified. 11 (9.4%) requests were considered inappropriate (e.g. secondary hyperparathyroidism, hypercalcemia of malignancy). Of the 106 patients with PHPT, 71 (67%) had at least one indication for surgery or patient’s preference for surgery clearly documented in notes.

Mean age was 62.6±14.3 and 76% were females. Mean adjusted calcium levels were 2.75±0.14 mmol/l, PTH 12.2±5.6 pmol/l and 25OHD 65.3±28.9 nmol/l. 18.9% of patients had a history of kidney stones and 23.6% had osteoporosis. DXA data were available for 82 patients. Mean T-score was −1.1±1.6 for lumbar spine, −1.2±1 for femoral neck and −0.7±1 for total hip.

Of the 106 patients, 62 (58%) had surgery, 57 of whom in our hospital and data on outcomes were available.

Of 35 patients who had no indication for surgery, 20 had negative Sestamibi and 3 (15%) of them had parathyroidectomy, while 15 had positive Sestamibi and 13 (86.7%) of them had parathyroidectomy. Surgery was successful in 15 (93.6%).

Among 71 patients with an indication for surgery, Sestamibi was positive in 30 (42%) patients and 41 patients in total (58%) had parathyroidectomy. Surgery was successful in 40 (95%).

Conclusion: Patients with positive imaging were more likely to be referred for surgery, even in the absence of a clear indication.

We suggest that Sestamibi scans are requested only by endocrinologists or surgeons and only when surgery is planned.

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