Bilateral Internal Jugular Venous Sampling for Parathyroid Hormone Determination in Patients with Nonlocalizing Primary Hyperparathyroidism

Abstract

In our hands, BIJVS for PTH determination was not a useful adjunctive test facilitating FP. We continue to offer all patients with PHPT and a negative sestamibi scan a standard bilateral neck exploration.

Outcomes of parathyroidectomy for primary hyperparathyroidism with nonlocalizing preoperative imaging

“…Past reports have noted gland sizes ranging from 36% to 58% smaller in patients with equivocal 99m Tc sestamibi, which align closely with the difference in gland size of 52% (572 mg vs 1102 mg) seen in our series. 15,17,19,20 While our series uncovered no difference in preoperative calcium levels, PTH was significantly lower in patients with double negative imaging (186 pg/mL vs 242 pg/mL; P = .01). 7,14,16 Although previous small series have suggested an incidence of MGD as high as 24%-84% in patients with double negative imaging, 7,14,16 in our large series, the incidence was only 21.7%, although this was significantly greater than the incidence in localized disease both in our series (8.8%) and the literature.…”

Pathologic Fractures: A Neglected Clinical Feature of Parathyroid Adenoma

“…Imaging studies are not used to diagnosis, confirm, and to decide on surgical therapy of hyperparathyroidism [9, 10]. If a limited parathyroid exploration is to be attempted, a localizing study is necessary [9–11]. In patients who have recurrent or persistent hyperparathyroidism after a previous surgery, an imaging study will be necessary [12], in which the T99m nuclear scan is the best initial test [4, 10].…”

“…In the case of 4 gland disease, 3.5 gland parathyroidectomy must be performed. Approximately 50–70 mg of the most normal appearing glands must be left intact [4, 8, 11]. In this case three other parathyroid glands examined during surgery, all was normal thus only the adenomatous gland was removed.…”

Primärer Hyperparathyreoidismus – aktuelle Diagnostik und Therapie

“…Die selektive venöse PTH-Bestimmung aus den Halsvenen kann bei der Rezidivoperation eines pHPT eine entscheidende Hilfe für die Lokalisation des Adenoms darstellen, zeigte in der Primärdiagnostik jedoch keinen Nutzen [16]. Die Untersuchung ist extrem untersucherabhängig und sollte nur in erfahrenen Zentren durchgeführt werden.…”