Endocrine Abstracts

Aims: Determine the utility of ultrasonography for the preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism and to compare this method with ^99mtechnetium sestamibi scintigraphy.

Methods: The results of ultrasonographic localization of enlarged parathyroid glands witch were performed by one experienced ultrasonographer were determined in 65 consecutive patients with primary hyperparathyroidism and compared with findings at surgery and results of ^99mtechnetium sestamibi scintigraphy. All patients had biochemically documented primary hyperparathyroidism based on elevated serum calcium and parathyroid hormone.

Results: Ultrasonography detected putative enlarged parathyroid glands in 49 of 65 patients (74.4%) with sensitivity of 83% and positive predictive value of 89%. Sestamibi scintigraphy was positive in 55 patients (84.6%) with sensitivity of 88.7% and positive predictive value of 94.8%. there was no significant deference between ultrasonography and scintigraphy in localization of adenomas. There was a correlation between PTH level and scintigraphic localization of adenoma (P=0.001). If both ultrasonography and scintigraphy used for localization, they located 61 adenomas (93.8%) with sensitivity of 93.8% and positive predictive value of 95%.

Conclusion: Ultrasonography is a sensitive and accurate method for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism, comparable in overall utility with sestamibi scintigraphy. These results suggest that a strategy of initial testing with one or the other method, followed by the alternate imaging test if the first test is negative, would provide correct parathyroid adenoma imaging.