Endocrine Abstracts

Introduction and aim: Primary hyperparathyroidism is the commonest cause of hypercalcaemia in out patient population. Primary hyperparathyroidism has become relatively common over the recent years as calcium levels are routinely evaluated since the introduction of multichannel analysers worldwide. Our aim was to audit the use and role of preoperative imaging (Ultrasound and Sestamibi scan) in localising parathyroid adenoma.

Methods: We reviewed case notes of 26 patients with diagnosis of primary hyperparathyroidism who underwent imaging at University Hospital of North Durham between September 2005 and February 2007. Nineteen patients underwent parathyroid surgery.

Results: Parathyroid adenoma was localised by ultrasound in 15 patients (58%) as against 21 (80%) by Sestamibi scan. Sestamibi/Ultrasound concordance was 13/21 (61%). Out of the 19 patients who underwent surgery 16 (84%) had adenoma, 1 (5.3%) had hyperplasia and 2 (10.5%) had normal tissue on histology. In 2 patients (7.7%), surgery was either not indicated or contraindicated. We found the concordance between Sestamibi and surgery of 84% (16/19) and that with histology of 79% (15/19). On the contrary, ultrasound concordance with surgery was 58% (11/19) and histology was 53% (10/19).

Conclusion: Sestamibi was found to localise parathyroid adenomas with high degree of accuracy in our hospital. Role of neck ultrasound was complimentary. Imaging should be avoided in patients in whom surgery is contraindicated or not indicated for rational use of resources.