Imaging of the parathyroid glands in primary hyperparathyroidism

Abstract

Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral neck exploration under general anaesthesia has been the standard for the definitive treatment. However, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before an operation (both in the classical scenario and in the minimally invasive procedure). They are not satisfied by having been referred a patient with just a biochemical diagnosis of PHPT. Imaging studies must not be utilized to make the diagnosis of PHPT. They should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localization. Therefore, surgical expertise is more important than the search for abnormal parathyroid glands.

Incidental thyroid carcinomas. A retrospective study

“…The incidence of carcinomas in the cervicomediastinal goiter compared with benign thyroid cervical-mediastinum disease, is around 12.1% (50,51). The association with parathyroid diseases (52)(53)(54)(55)(56) and lymphocytic thyroiditis (57, 58) is also described.…”

Parathyroid Adenomas in Adults and Adolescents. Critical Appraisal and Surgical Strategy in 18 Cases

“…Diagnosis of PHP remain essentially based on laboratory findings of persistent hypercalcemia associated with plasma levels of PTH that are elevated or inappropriately normal together with pre and intraoperative cervical ultrasonography and parathyroid scintigraphy acknowledged as the first-line method used to located pathological parathyroid tissues (23,24).…”

An unusual mediastinal parathyroid carcinoma coproducing PTH and PTHrP: A case report

“…PTCA and PTA have similar clinical and biochemical symptoms, and histological features alone often cannot entirely distinguish between them, therefore it may be difficult to diagnose PTCA (15). However, patients with PTCA have severe hypercalcemia (>15 mg/dl; normal range, 8.02-10.42 mg/dl) and markedly elevated PTH (>300 pg/ml; normal range, 15-65 pg/ml) (2).…”