Endocrine Abstracts

Background: The Ultrasonography (USS) and Tc-SestaMiBi (MiBi) scans are established tests to localize parathyroid adenoma. It is important to utilize these appropriately prior to surgery for a positive outcome.

Method: It was a retrospective study in patients diagnosed with primary hyperparathyroidism (PHPT) according to the NICE Guideline who underwent parathyroidectomy from 01/01/2015 to 31/12/2019. We aimed to assess the USS and Tc-Sestamibi scan’s effectiveness in the preoperative localization of parathyroid lesions and concordance with the operative and histological results.

Results: There was a total of 159 patients, of whom, 31(19.5%) were male with a mean age of 63 years. Their mean biochemical markers were corrected calcium level (2.89 mg/dl), PTH level (26.5 ng/l), vitamin D level (60 ng/ml) and eGFR (70.1). The 78 patients underwent parathyroidectomy while 71 patients were managed conservatively. The 10 patients missed their clinic appointments. Of the 78 patients who underwent surgery, the 26 (33.5%) patients’ USS and MiBi scan findings were concordant with pre-operative and histological findings. 84.6% had adenoma, 11.5% had normal parathyroid and 3.8% had hyperplasia. 93% of patient’s hypercalcemia was resolved following the surgical intervention. The non-concordance of both scans with operative and histological results were 21 (26.9%) patients. The 20 patients had adenoma while 1 had normal parathyroid. The patient (9%) developed recurrence hypercalcemia. The 17 (21.7%) patients had adenoma which was consistent only with MiBi scan and no recurrence. The 14 (17.9%) patients had concordance between pre-operative findings and USS (10 had adenoma, 3 had normal parathyroid and 1 had hyperplasia). There was only one recurrence PHPT.

Conclusion: Both USS and MiBi scans should be used to localize adenoma pre-operatively and the non-concordant cases should be discussed in the MDT meetings to improve the surgical outcome for such patients.