Endocrine Abstracts

Introduction: Preoperative localization of parathyroid adenomas still remains a problem, despite advances in imaging of the parathyroid gland. The purpose of our presentation was to present our attitude in the diagnosis and the treatment of parathyroid adenomas and in case of recurrence.

Method: Our study includes 33 cases of primary hyperparathyroidism treated in our department, during a period of 15 years (2002–2017). All patients were referred from the endocrinology department after the biological diagnosis was made and the surgical indication was discussed.

Results: The average age was 55 years old with extremes of 20–80. They were 24 women and 9 men. Patients presented with complaint of asthenia, polyuria, polydipsia associated with bone pain in 17 cases. All our patients were systematically explored by cervical ultrasonography, Thallium-Technetium scintigraphy in two cases and 99Tc-sestamibi in 31 cases. The preoperative localization of the adenoma was done in 28 cases. 99Tc-sestamimbi scintigraphy revealed parathyroid hypertrophy in 26 patients and perfectly localized them. Thallium-Tc scintigraphy was helpful in one patient, while it missed a 15 mm right superior adenoma in another patient. Cervical ultrasonography showed same result with surgery in 21 patients. Cervico mediastinal CT scan was performed in five cases and MRI in one case. Peroperatively, double localization was noted in two patients. The efficiency of surgery was confirmed by a postoperative parathyroid hormone level monitoring. Surgical revision was necessary in three cases, for persistence of elevated parathyroid hormons levels (In one case it was a 1.2 cm adenoma found in left retrovascular position, in the second case it was a 0.8 cm adenoma localized in the the tracheoesophageal groove and the last case it was an intrathymic 1.5 cm adenoma). Postoperatively, a case of chondrocalcinosis was noted in one patient, severe hypocalcemia at 1.7 mmol/l was noted in a patient with a tetany crisis.

Conclusion: In terms of parathyroid adenomas, a well detailed preoperative imaging done by an experienced radiologist is of great help for the surgeon but does not necessarily lead to a better success rate compared to conventional bilateral neck surgical exploration.