Endocrine Abstracts

Diagnosis of primary hyperparathyroidism is often made incidentally following routine biochemical screening. Parathyroidectomy is usually carried out in patients at risk of disease progression or with clinical features that may improve and that is in line with NIH guidance. Current recommendations suggest that Minimally Invasive Parathyroidectomy (MIP) should take place only if sestamibi and ultrasound findings are concordant. We studied the medical notes of 53 patients, aged 40–83 years who had parathyroidectomy for primary hyperparathyroidism to evaluate indications of surgery, pre-surgical localisation of parathyroid lesion and outcome. 46 (87%) patients fulfilled NIH criteria for surgery, 47% of these patients had osteoporosis, 24% had hypercalcaemia, 45% had eGFR<60 ml/min and 8% were younger than 50. All patients (100%) had localisation testing before surgery, 91% of patients had both Sestamibi and ultrasound localisation and 9% had Sestamibi only. Sestamibi and ultrasound findings correlated in 64% of patients. MIP was carried out in 28 (53%) patients, 17 (32%) patients underwent bilateral neck exploration, 8 (15%) patients had initial MIP converted to bilateral surgery. Those who had correlated Sestamibi and ultrasound findings, 17 of them had MIP, 6 patients had bilateral neck exploration and 4 patients had converted surgery, and all those who had correlated scans and MIP (100%) had successful surgery with normalisation of calcium. Nine patients who had discordant imaging underwent MIP, 8 (89%) had successful surgery. Nine percent of patients had sestamibi only and Intraoperative findings correlated with localisation in all (100%). Surgery was successful with normalisation of calcium in 91% of all patients, 96% of those with MIP, 84% with bilateral neck exploration. Length of stay was shorter with MIP compared to bilateral exploration (0.93 vs 1.16 days). MIP is effective mean in managing primary hyperparathyroid, especially if Sestamibi and ultrasound findings are correlated, and can result in reduced length of stay.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.