Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy

Vitetta, Giovanni Mariano; Neri, Pierluigi; Chiecchio, Andrea; Carriero, Alessandro; Cirillo, Stefano; Mussetto, Annalisa Balbo; Codegone, A.

doi:10.1007/s40477-014-0067-8

Cited by 51 publications

(37 citation statements)

References 33 publications

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“…These can also occur in cases of thyroid nodules or concomitant Hashimoto's thyroiditis. The sensitivity of US technique is strongly dependent on the operator's experience, being about 84% when performed by an experienced doctor (7). Advantages of the US technique include low cost, wide availability, absence of ionizing radiation exposure, together with the possibility of evaluating concomitant thyroid disease (8).…”

Section: Introductionmentioning

confidence: 99%

Imaging of the parathyroid glands in primary hyperparathyroidism

Minisola¹,

Cipriani²,

Diacinti³

et al. 2016

European Journal of Endocrinology

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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.

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Section: Introductionmentioning

confidence: 99%

Imaging of the parathyroid glands in primary hyperparathyroidism

Minisola¹,

Cipriani²,

Diacinti³

et al. 2016

European Journal of Endocrinology

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“…In particular, both modalities lack detail regarding surrounding anatomy, and sonography is highly operator-dependent. [5][6][7] In the past decade, multiphase CT has emerged as an additional technique for adenoma localization. 1,2,[8][9][10][11][12][13][14] In addition to lesion identification, CT allows precise localization based on welldefined anatomic landmarks.…”

mentioning

confidence: 99%

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Griffith¹,

Chaudhary

Mahmood

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Minimally invasive parathyroidectomy requires accurate preoperative localization of suspected adenomas, and multiphase CT allows adenoma characterization while providing detailed anatomic information. The purpose of this study was to assess the feasibility of a protocol using only arterial and venous phases to localize pathologic glands in patients with primary hyperparathyroidism.

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“…However, the sensitivity of ultrasonography fluctuates between 22% and 80%, because it is user dependent and limited in its ability to localize retroesophageal, retrotracheal, retrosternal, intrathyroidal, mediastinal, small, and deep cervical glands [41,48,49]. Vitetta et al found that sonography performed by an expert was associated with an appreciably superior diagnostic yield than 99mTc sestamibi [50]. Thus, ultrasound can be used as the main method for preoperative localization of pathological parathyroid tissues [50].…”

Section: Differential Diagnosis and Work-upmentioning

confidence: 99%

“…Vitetta et al found that sonography performed by an expert was associated with an appreciably superior diagnostic yield than 99mTc sestamibi [50]. Thus, ultrasound can be used as the main method for preoperative localization of pathological parathyroid tissues [50].…”

Section: Differential Diagnosis and Work-upmentioning

confidence: 99%

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

Alhefdhi¹

2015

Surgery

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Review ArticleOpen Access IntroductionPrimary hyperparathyroidism (PHPT) is defined by an abnormal increase in the intrinsic activity of the parathyroid gland(s) that result in elevated parathyroid hormone (PTH) levels [1,2]. It is one of the most common endocrine disorders and is the most common cause of hypercalcemia. PHPT is one of the most common endocrine disorders and is the most common cause of hypercalcemia, which increases morbidity and mortality that result from cardiovascular, renal, and musculoskeletal pathologies. PHPT affects 1 in 500 females and 1 in 2,000 males aged >40 years, with a peak incidence in post-menopausal women. In the US, Europe, and Australia, the reported estimated incidence rates range from 25 to 30 per 100,000 person years, and the prevalence range from 1 to 21 per 1,000 individuals [1][2][3][4].PHPT has been a recognizable disease since the 1920s in both Europe and the US [5]. The first parathyroidectomy was performed in 1925 by Felix Mandl in Vienna, Austria; since then, the diagnosis and management of PHPT have progressed [5]. The purpose of this article is to review the current trends of PPT presentation, work-up, and management. Anatomy and PhysiologyHumans typically have four parathyroid glands located at the posterior capsule of the thyroid gland; in up to 15% of individuals have more than four and up to 3% have three identifiable glands [6]. The superior parathyroid glands arise from the IV pharyngeal pouch and migrate to the cephalad thyroid gland; they are usually located at the cricothyroid junction, 1 cm from the recurrent laryngeal nerve and the inferior thyroid artery. Inferior parathyroid glands arise from the III pharyngeal pouch and migrate caudally with the thymus; they are usually located on the posterolateral aspect of the inferior pole of the thyroid gland. Normal parathyroid glands are yellow or brown in color, oval in shape, 3-7 mm in length, and 30-40 mg in weight [7,8].A parathyroid gland consists of chief cells, oxyphilic cells, a thin fibrous capsule, and a network of adipose tissue, blood vessels, and glandular parenchyma [8]. Chief cells secrete PTH, which consists of 84 amino acid polypeptides. The normal serum PTH level range is 15-72 pg/mL, with a half-life of 2-4 min. Seventy percent of PTH metabolism occurs in the liver and 30% in the kidneys [9][10][11]. PTH is regulated by serum calcium, phosphorus, and vitamin D metabolites. The total normal calcium level should be 8.8-10.2 mg/dL (ionized calcium 2.2-2.6 mmol/L) to ensure optimum physiological functions [9][10][11]. PTH levels are inversely proportional to serum calcium levels, as high serum calcium levels decrease PTH release [5][6][7] and low serum calcium levels increase PTH secretion. This relationship enhances renal tubular calcium reabsorption, urinary phosphate excretion, osteoclastmediated bone resorption, and the conversion of 25-hydroxyvitamin D3 into 1,25-hydroxyvitamin D3, which increases calcium absorption from the bowel [9-11]. EtiologyNinety-five percent of PHPT cases are spora...

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Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy

Cited by 51 publications

References 33 publications

Imaging of the parathyroid glands in primary hyperparathyroidism

Imaging of the parathyroid glands in primary hyperparathyroidism

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

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