Primary hyperparathyroidism: is there a role for imaging?

Excerpt

When posing the question as to whether attempts should be undertaken to localise a parathyroid adenoma with imaging studies prior to surgical neck exploration in patients with primary hyperparathyroidism, the individual preoperative scenario has to be considered. Nobody will dispute the necessity of imaging studies in a patient who has persistent or recurrent hyperparathyroidism after previous neck exploration or who needs parathyroidectomy after previous thyroid surgery. A limited and focussed approach to a preoperatively localised parathyroid adenoma significantly reduces the extent of dissection and thereby operative morbidity, which is markedly higher in reoperative neck surgery than in primary explorations. It has even been suggested that imaging studies should be continued in these cases until the enlarged parathyroid gland is localised with two independent diagnostic tests at the same position [1, 2]. This policy does not appear to be justified any longer, considering the very high specificity of ^99mTc-sestamibi scintigraphy. Furthermore, quick parathyroid hormone (PTH) assay is now available not only as a means for the intraoperative control of operative success but also as a tool for intraoperative regionalisation of the adenoma, which will most likely reduce the need for preoperative imaging studies even further in these conditions. …