Endocrine Abstracts

Introduction: Primary hyperparathyroidism is not an uncommon disease with incidence of ~25–30 cases per 100 000 people, whether caused by adenoma or hyperplasia, can be cured surgically with a high rate of success. Over past decade minimally invasive surgery has become mainstay of treatment compared to traditional bilateral exploration approach. Accurate preoperative localisation of parathyroid disease is absolutely imperative for effective minimally invasive surgery.

Aim: To assess the effectiveness of ultrasound and Sestamibi scan in localising parathyroid adenoma in our hospital and compare with universal results.

Methodology and results: Retrospective study of 50 patients who underwent parathyroidectomy. Radiology results were compared with histological and operative notes. We audited 50 patients, out of which 28 were females and 22 males. Average age was 59 years and females slightly older than males.

Out of 50 patients 39 patients had primary hyperparathyroidism.

Out of 39 patients with primary hyperparathyroidism, 38/39 (97%) had ultrasound, 36/39 (92%) had Sestamibi scan.

26/38 (68%) had evidence of adenoma on ultrasound, 19/36 (53%) patients had adenoma on the Sestamibi scan. Concordance between ultrasound and Sestamibi was 33% (12/36) preoperatively.

Of 39 patients with primary hyperparathyroidism, histological findings showed, adenoma in 29/39 (75%), hyperplasia in 8/39 (20%), 1/39 (2.5%) had normal parathyroid tissue and 1 (2.5%) had no parathyroid tissue identified.

Out of 39 patients with primary hyperparathyroidism, postoperatively ultrasound localised the site of adenoma in 24/38 (63%) patients, Sestamibi localised in 20/38 (53%) patients. US and Sestamibi concordance was 29/38 (76%) postoperatively.

Conclusion: Ultrasound was slightly more accurate in localising parathyroid adenoma than Sestamibi scan in patients with primary hyperparathyroidism in our hospital. Concordance with both modalities was only 73 percent compared to 90–95% percent in various studies. Both US and sestamibi scans should be used whenever available to localise adenomas preoperatively for patients to undergo minimally invasive surgery and prevent complications with traditional bilateral exploration.