Endocrine Abstracts

Aims: Primary hyperparathyroidism is a common endocrine disorder. A preoperative approach that combines ultra-sonography and scintigraphy has been shown to predict the presence of adenomas more accurately than either technique alone. We aimed to investigate our local success rates using dual localisation for parathyroid adenomas.

Methods: Endocrine patients who had a parathyroidectomy between July 2006 and January 2008 were identified. Hospital notes were reviewed retrospectively.

Results: Forty one endocrine patients had a parathyroidectomy between July 2006 and January 2008. Ten sets of notes were missing. Of the 31 endocrine patients, 23 were female, 8 were male, mean age 60 years (35–79). Mean time from diagnosis was 5 years (1–9).

Indication for surgery: Seventy four percent (23/31) were clinically symptomatic; 68% (21/31) had a calcium >2.85 mmol/l, 45% (14/31) had osteoporosis, 39% (12/31) had a urine Ca >9 mmol/l, 9.7% (3/31) had sustained fractures and 6.4% (2/31) had renal stones.

Investigations: Mean pre-operative PTH was 177 (56–466) and calcium 2.84 mmol/l (2.37–3.2). Scintigraphy scan correctly identified an adenoma in 93% (28/30) of patients. Sonography correctly identified an adenoma in 90% (27/30) of patients. Two patients did not have dual localisation (one had an adenoma identified on sonography alone, the other had an adenoma identified on scintigraphy alone). Combining sonography and scintigraphy investigations resulted in correct identification of an adenoma in 93% (28/29) patients. The sonography-negative, scintigraphy-negative patient had an adenoma identified on CT scan. All patients had curative surgery. 3 patients developed post-operative hypocalcaemia, one of which was symptomatic.

Conclusions: Dual localisation of parathyroid adenoma using sonography and sestmibi successfully locates parathyroid adenomas. Surgery was curative in all cases with an acceptable complication rate.