Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2017) 50 P057 | DOI: 10.1530/endoabs.50.P057

SFEBES2017 Poster Presentations Bone and Calcium (27 abstracts)

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

Anastasia Dede 1 , Daniel Morganstein 1 , Kevin Shotliff 1 , Veronica Greener 1 , James Smellie 2 , Annelies Maenhout 3 & Alison Wren 1


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.

Volume 50

Society for Endocrinology BES 2017

Harrogate, UK
06 Nov 2017 - 08 Nov 2017

Society for Endocrinology 

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