Endocrine Abstracts

Background: We studied a cohort of hyperparathyroid patients in order to elucidate their clinical, laboratory, radiological and histological findings; the role of diagnostic imaging and concomitant thyroid pathologies.

Method: 48 patients met our inclusion criteria for hypercalcaemic primary hyperparathyroidism (pHPT). We documented patients’ demographic data, symptomatology, associated conditions and treatment and analysed the work-up, management and outcomes for each of these patients.

Results: pHPT patients had a median age of 62 years (range 20–79), median PTH of 145.5 pg/ml (range 27–4660) and mean serum calcium of 2.94 mmol/l (S.D.±0.33), while those operated (30/48, 62.5%) had a median age of 60 years (range 20–79), mean calcium of 3.02 mmol/l (S.D.±0.39) and a median PTH of 176 pg/ml (range 37–4660). Histology showed parathyroid adenoma in 16/30 (53.3%), hyperplasia in 8/30 (26.7%), parathyroid carcinoma in 1/30 and normal tissue in 5/30. 19 of the 30 operated patients had a positive sestamibi scan of which 14/19 (73.7%) had an adenoma, 3/19 (15.8%) had hyperplasia, 1/19 had a carcinoma, and 1/19 had normal histology. Out of the 11 patients who had a negative sestamibi scan, 8/10 also had a negative ultrasound (US) and histologically 2/11 (18.2%) had an adenoma, 5/11(45.5%) had hyperplasia and 4/11 (36.4%) had normal histology.

Thyroid US showed a multinodular goitre in 12/41 (29.3%), solitary nodule in 5/41 (12.2%) thryoiditis in 4/41 (9.8%) and normal thyroid morphology in 20/41 (48.8%).

Conclusion: Parathyroid adenoma is the commonest pathology in patients with positive parathyroid imaging while hyperplasia is commoner in scan negative patients. This study highlights the need to proceed with surgery even when imaging is negative if clinically indicated. It is important to investigate associated thyroid pathology prior to surgery though our data suggests similar incidence of thyroid pathology as documented in the general population.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.