Top

Endocrine

Published in:

01-04-2018 | Endocrine Methods and Techniques

Pre-operative localization of abnormal parathyroid tissue by ^99mTc-sestamibi in primary hyperparathyroidism using four-quadrant site analysis: an evaluation of the predictive value of vitamin D deficiency

Authors: Yu-Kwang Donovan Tay, Randy Yeh, Jennifer H. Kuo, Catherine McManus, James A. Lee, John P. Bilezikian

Published in: Endocrine | Issue 1/2018

Abstract

Context

Accurate preoperative localization of abnormal parathyroid tissue aids importantly in minimally invasive parathyroidectomy in patients with primary hyperparathyroidism. Vitamin D deficiency may possibly influence the success and characteristics of pre-operative localization because it is associated with more active disease and possibly larger adenomas. This could increase the sensitivity of the sestamibi to identify abnormal parathyroid tissue, but earlier reports are conflicting. Vitamin D deficiency could also influence the nature of preoperative localization because it could lead to multi-gland stimulation of parathyroid tissue giving an appearance of multi-gland disease, which may lower accuracy of preoperative localization with sestamibi.

Objective

To examine the relationship between vitamin D deficiency and correct parathyroid tissue localization by four-pole thyroid quadrant analysis.

Design

Retrospective study.

Setting

Referral center.

Participants

A total of 138 patients were divided into three groups according to the level of 25OHD; <20 ng/mL (vitamin D deficient), ≥20 to <30 ng/mL (vitamin D insufficient) and ≥30 ng/mL (vitamin D replete).

Main outcomes

Quadrant localization using ^99mTc-sestamibi/SPECT.

Results

Among those with single-gland disease, the proportion of patients with correct quadrant localization were 60.0, 68.3 and 63.5% (p = 0.778), and the accuracy of sestamibi was 89.3, 90.6 and 89.9% for the deficient, insufficiency and replete groups, respectively. Among those with multi-gland disease, the proportion of patients with correct quadrant localization were 50.0, 25.0 and 18.2% (p = 0.619) while the accuracy was 50.0, 50.0 and 45.5%, respectively. Multi-gland disease did not occur more frequently in any of the three groups (p = 0.296).

Conclusions

Vitamin D levels do not affect the accuracy of preoperative localization with sestamibi.

R. Bellantone, M. Raffaelli, C. DE Crea, E. Traini, C.P. Lombardi, Minimally-invasive parathyroid surgery. Acta Otorhinolaryngol. Ital. 31, 207–215 (2011)PubMedPubMedCentral

G.A. Lumb, S.W. Stanbury, Parathyroid function in human vitamin D deficiency and vitamin D deficiency in primary hyperparathyroidism. Am. J. Med. 56, 833–839 (1974). https://doi.org/10.1016/0002-9343(74)90812-2 CrossRefPubMed

S.J. Silverberg, E. Shane, D.W. Dempster, J.P. Bilezikian, The effects of vitamin D insufficiency in patients with primary hyperparathyroidism. Am. J. Med. 107, 561–567 (1999). https://doi.org/10.1016/S0002-9343(99)00294-6 CrossRefPubMed

D.S. Rao et al. Effect of vitamin D nutrition on parathyroid adenoma weight: pathogenetic and clinical implications. J. Clin. Endocrinol. Metab. 85, 1054–1058 (2000). https://doi.org/10.1210/jcem.85.3.6440 PubMed

M.D. Walker et al. Vitamin D in primary hyperparathyroidism: effects on clinical, biochemical, and densitometric presentation. J. Clin. Endocrinol. Metab. 100, 3443–3451 (2015). https://doi.org/10.1210/jc.2015-2022 CrossRefPubMedPubMedCentral

H. Raef et al. The effect of vitamin D status on the severity of bone disease and on the other features of primary hyperparathyroidism (pHPT) in a vitamin D deficient region. J. Endocrinol. Invest. 27, 807–812 (2004). https://doi.org/10.1007/bf03346273 CrossRefPubMed

H.R. Bartos, P.H. Henneman, Parathyroid hyperplasia in osteomalacia. J. Clin. Endocrinol. Metab. 25, 1522–1523 (1965). https://doi.org/10.1210/jcem-25-11-1522 CrossRefPubMed

K.J. Nichols, G.G. Tronco, C.J. Palestro, Influence of multigland parathyroid disease on 99mTc-sestamibi SPECT/CT. Clin. Nucl. Med. 41, 282–288 (2016). https://doi.org/10.1097/RLU.0000000000001115 CrossRefPubMed

L. De Gregorio et al. The truth about double adenomas: incidence, localization, and intraoperative parathyroid hormone. J. Am. Coll. Surg. 222, 1044–1052 (2016). https://doi.org/10.1016/j.jamcollsurg.2015.12.048 CrossRefPubMed

10.

E. Kandil, A.P. Tufaro, K.A. Carson et al. Correlation of plasma 25-hydroxyvitamin d levels with severity of primary hyperparathyroidism and likelihood of parathyroid adenoma localization on sestamibi scan. Arch. Otolaryngol. Neck Surg. 134, 1071–1075 (2008). https://doi.org/10.1001/archotol.134.10.1071 CrossRef

11.

M. Schmidt et al. 99mTc-MIBI SPECT in primary hyperparathyroidism—influence of concomitant vitamin D deficiency for visualization of parathyroid adenomas. Nuklearmedizin 47, 1–7 (2008). https://doi.org/10.3413/nukmed-0057 PubMed

12.

F. Tassone et al. Vitamin D deficiency does not affect the likelihood of presurgical localization in asymptomatic primary hyperparathyroidism. Endocr. Pract. 22, 205–209 (2016). https://doi.org/10.4158/ep15977.or CrossRefPubMed

13.

H.K. Eslamy, H.A. Ziessman, Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics 28, 1461–1476 (2008). https://doi.org/10.1148/rg.285075055 CrossRefPubMed

14.

D.M. Carneiro, C.C. Solorzano, M.C. Nader, M. Ramirez, G.L. Irvin, Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery 134, 973–979 (2003). https://doi.org/10.1016/j.surg.2003.06.001 CrossRefPubMed

15.

M.F. Holick et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 96, 1911–1930 (2011). https://doi.org/10.1210/jc.2011-0385 CrossRefPubMed

16.

B. Moosgaard et al. Vitamin D status, seasonal variations, parathyroid adenoma weight and bone mineral density in primary hyperparathyroidism. Clin. Endocrinol. (Oxf.). 63, 506–513 (2005). https://doi.org/10.1111/j.1365-2265.2005.02371.x CrossRefPubMed

17.

P. Boudou, F. Ibrahim, C. Cormier, E. Sarfati, J.C. Souberbielle, A very high incidence of low 25 hydroxy-vitamin D serum concentration in a French population of patients with primary hyperparathyroidism. J. Endocrinol. Invest. 29, 511–515 (2006). https://doi.org/10.1007/bf03344140 CrossRefPubMed

18.

M.R. Clements et al. Metabolic inactivation of vitamin D is enhanced in primary hyperparathyroidism. Clin. Sci. 73, 659–664 (1987). https://doi.org/10.1042/cs0730659 CrossRefPubMed

19.

M.R. Clements et al. The role of 1,25-dihydroxyvitamin D in the mechanism of acquired vitamin D deficiency. Clin. Endocrinol. (Oxf.). 37, 17–27 (1992). https://doi.org/10.1111/j.1365-2265.1992.tb02278.x CrossRefPubMed

20.

C. Theodoropoulos, C. Demers, J.-L. Petit, M. Gascon-Barré, High sensitivity of rat hepatic vitamin D33-25 hydroxylase CYP27A to 1,25-dihydroxyvitamin D33 administration. Am. J. Physiol. Endocrinol. Metab. 284, E138–E147 (2003). https://doi.org/10.1152/ajpendo.00303.2002 CrossRefPubMed

21.

C.K. Kramer et al. The relationship between parathyroid hormone and 25-hydroxyvitamin D during and after pregnancy. J. Clin. Endocrinol. Metab. 101, 1729–1736 (2016). https://doi.org/10.1210/jc.2015-4060 CrossRefPubMed

22.

S.A. Shapses, E.J. Lee, D. Sukumar, R. Durazo-Arvizu, S.H. Schneider, The effect of obesity on the relationship between serum parathyroid hormone and 25-hydroxyvitamin D in women. J. Clin. Endocrinol. Metab. 98, E886–E890 (2013). https://doi.org/10.1210/jc.2012-3369 CrossRefPubMedPubMedCentral

23.

A.J. Sai, R.W. Walters, X. Fang, J.C. Gallagher, Relationship between vitamin D, parathyroid hormone, and bone health. J. Clin. Endocrinol. & Metab. 96, E436–E446 (2011). https://doi.org/10.1210/jc.2010-1886 CrossRef

24.

J. Pepe et al. Vitamin D status as the major factor determining the circulating levels of parathyroid hormone: a study in normal subjects. Osteoporos. Int. 16, 805–812 (2005). https://doi.org/10.1007/s00198-004-1757-4 CrossRefPubMed

25.

C.D. Adkisson et al. Predictors of accuracy in preoperative parathyroid adenoma localization using ultrasound and Tc-99 m-Sestamibi: a 4-quadrant analysis. Am. J. Otolaryngol. 34, 508–516 (2013). https://doi.org/10.1016/j.amjoto.2013.05.001 CrossRefPubMed

26.

C. Arici et al. Can localization studies be used to direct focused parathyroid operations? Surgery 129, 720–729 (2001). https://doi.org/10.1067/msy.2001.114556 CrossRefPubMed

27.

J.A. Glenn et al. Association between body mass index and multigland primary hyperparathyroidism. J. Surg. Res. 202, 132–138 (2016). https://doi.org/10.1016/j.jss.2015.12.055 CrossRefPubMed

28.

E. Berber et al. Factors contributing to negative parathyroid localization: an analysis of 1000 patients. Surgery 144, 74–79 (2008). https://doi.org/10.1016/j.surg.2008.03.019 CrossRefPubMed

29.

J.I. Merlino, K. Ko, A. Minotti, C.R. McHenry, The false negative technetium-99m-sestamibi scan in patients with primary hyperparathyroidism: correlation with clinical factors and operative findings. Am. Surg. 69, 225–229 (2003). discussion 229–230PubMed

30.

Z.-L. Qiu, B. Wu, C.-T. Shen, R.-S. Zhu, Q.-Y. Luo, Dual-phase 99mTc-MIBI scintigraphy with delayed neck and thorax SPECT/CT and bone scintigraphy in patients with primary hyperparathyroidism: correlation with clinical or pathological variables. Ann. Nucl. Med. 28, 725–735 (2014). https://doi.org/10.1007/s12149-014-0876-z CrossRefPubMed

31.

A.E. Stephen, S.I. Roth, D.W. Fardo et al. Predictors of an accurate preoperative sestamibi scan for single-gland parathyroid adenomas. Arch. Surg. 142, 381–386 (2007). https://doi.org/10.1001/archsurg.142.4.381 CrossRefPubMed

32.

S. Rodríguez-Carranza et al. Localization of parathyroid adenomas by 99mTc-sestamibi scanning: upper neck versus lower neck lesions. Endocr. Pract. 10, 472–477 (2004). https://doi.org/10.4158/ep.10.6.472 CrossRefPubMed

33.

R. Phitayakorn, C.R. McHenry, Incidence and location of ectopic abnormal parathyroid glands. Am. J. Surg. 191, 418–423 (2006). https://doi.org/10.1016/j.amjsurg.2005.10.049 CrossRefPubMed

34.

M.D. Walker et al. Low vitamin D levels have become less common in primary hyperparathyroidism. Osteoporos. Int. 26, 2837–2843 (2015). https://doi.org/10.1007/s00198-015-3199-6 CrossRefPubMedPubMedCentral

35.

G.J. Hunter, D. Schellingerhout, T.H. Vu, N.D. Perrier, L.M. Hamberg, Accuracy of four-dimensional CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Radiology 264, 789–795 (2012). https://doi.org/10.1148/radiol.12110852 CrossRefPubMed

Title: Pre-operative localization of abnormal parathyroid tissue by 99mTc-sestamibi in primary hyperparathyroidism using four-quadrant site analysis: an evaluation of the predictive value of vitamin D deficiency
Authors: Yu-Kwang Donovan Tay
Randy Yeh
Jennifer H. Kuo
Catherine McManus
James A. Lee
John P. Bilezikian
Publication date: 01-04-2018
Publisher: Springer US
Published in: Endocrine / Issue 1/2018
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-018-1528-1

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pre-operative localization of abnormal parathyroid tissue by ^99mTc-sestamibi in primary hyperparathyroidism using four-quadrant site analysis: an evaluation of the predictive value of vitamin D deficiency

Abstract

Context

Objective

Design

Setting

Participants

Main outcomes

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Context

Objective

Design

Setting

Participants

Main outcomes

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Appraisal of clinical practice guidelines on the management of hypothyroidism in pregnancy using the Appraisal of Guidelines for Research and Evaluation II instrument

Female gonadal functions and ovarian reserve in patients with acromegaly: experience from a single tertiary center

Performance of Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) in discriminating indeterminate lesions at low and high risk of malignancy. A systematic review and meta-analysis

Blood pressure variability in primary hyperparathyroidism: more data needed

Long-term safety of long-acting octreotide in patients with diabetic retinopathy: results of pooled data from 2 randomized, double-blind, placebo-controlled phase 3 studies

Ambulatory blood pressure monitoring-derived short-term blood pressure variability in primary hyperparathyroidism

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page