Faculty Collaboration Database

Detection of multiple gland primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Surgery 2004 Dec;136(6):1303-9

Date

01/20/2005

Pubmed ID

15657591

DOI

10.1016/j.surg.2004.06.062

Scopus ID

2-s2.0-10644239282 (requires institutional sign-in at Scopus site)   88 Citations

Abstract

BACKGROUND: A focused surgical approach for primary hyperparathyroidism relies on the ability of preoperative imaging and intraoperative parathyroid hormone monitoring (IOPTH) to detect multiple gland disease (MGD). The study objective was to determine the best predictor for MGD.

METHODS: First time parathyroidectomy was performed on 233 patients with primary hyperparathyroidism who underwent preoperative sestamibi imaging, ultrasound, and IOPTH between December 1999 and January 2004.

RESULTS: Single gland disease (SGD) was found in 204 (88%) and MGD in 23 (10%) patients. Hyperparathyroidism persisted in 6 of 233 patients (2.6%). For patients with MGD, sestamibi imaging correctly predicted MGD in 2 of 23 (9%) patients, incorrectly showed SGD in 9 of 23 (39%), and was negative in 12 of 23 (52%). Ultrasound correctly predicted MGD in 6 of 23 (26%) patients, incorrectly predicted SGD in 6 of 23 (39%), and was negative in 8 of 23 (35%). Together sestamibi imaging and ultrasound predicted MGD in 7 of 23 (30%) patients, incorrectly predicted SGD in 7 of 23 (30%), was negative in 7 of 23 (30%), and was discordant in 10 of 23 (5%). IOPTH indicated MGD in 15 of 18 (83%) patients but falsely predicted cure after single gland excision in 3 of 18 (17%). The combination of sestamibi imaging, ultrasound, and IOPTH detected MGD in 16 of 18 (89%) patients.

CONCLUSION: Ultrasound was more sensitive for detecting MGD than sestamibi imaging. Ultrasound and sestamibi imaging together provided information warranting a bilateral approach in 70% of patients with MGD. IOPTH was the most sensitive for MGD, but combining all 3 tests was the best predictor, identifying the majority of patients with MGD.

Author List

Sugg SL, Krzywda EA, Demeure MJ, Wilson SD

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Hyperparathyroidism
Male
Middle Aged
Minimally Invasive Surgical Procedures
Parathyroid Hormone
Parathyroidectomy
Radiopharmaceuticals
Technetium Tc 99m Sestamibi
Ultrasonography