Endocrine Abstracts

Introduction

Primary Hyperparathyroidism (PHPT) results from one or more parathyroid glands hyperfunction. It is recommended that the preoperative location of the parathyroid lesion be performed with cervical ultrasonography and sestamibi-scintigraphy. Recently 4-Dimensional Computed Tomography (4D-CT) has revealed anatomic, morphologic and functional precision for detecting those lesions, either for typical or ectopic location. This study evaluates the diagnostic value of 4D-CT in the preoperative location and whether the severity of PHPT interferes with the success of this location.

Methods

Retrospective study with 34 patients attending with diagnosis of PHPT that performed 4D-CT for parathyroid lesion location. Variables such as age, gender, calcium (Ca), phosphorus (Ph), parathormone (PTH), cervical sonography, sestamibi-scintigraphy and 4D-CT were analysed. In patients who underwent surgical treatment we also analysed surgical criteria, histology and Ca, Ph and PTH postoperative values.

Results

34 patients were evaluated, with mean age of 67 years, 55.9% female. 73.5% had PHPT diagnosis and 26.5% had normocalcemic HPT. At diagnosis, patients had mean values of Ca, Ph and PTH of 10.7 mg/dl, 2.8 mg/dl and 161.2 pg/dl respectively. All patients performed cervical sonography, sestamibi-scintigraphy and 4D-CT. Positive location occurred in 70.6% (29.4% sonography; 38.2% scintigraphy and 55.9% 4D-CT). From those with identified lesion, 83.3% had one lesion and 16.7% multi-glandular lesions. There was a statistically significant positive correlation between the increase measure of Ca, Ph and PTH and the success of identifying the lesion, either in the 4D-CT or in any of the imaging tests (P < 0.01 in all). 9 patients underwent surgical treatment and all of them had image exams identifying a lesion (mean dimension of 16.3 mm). From those, 30% were evident on sonography, 60% on scintigraphy and 100% on 4D-CT. All patients were cured after surgery. After histological analysis of the respective lesions, there was a sensitivity of 100% for 4D-CT, 50% for scintigraphy and 40% for ultrasound.

Conclusion

4D-CT revealed to be a useful and reliable exam in the preoperative location of patients with PHPT. In patients that underwent surgical treatment, this image exam has shown a sensibility of 100%, result overlapping the literature (> 90%). Calcium, phosphorus and parathormone values seems to influence the success of lesion location.