Preoperative Localization Studies in Primary Hyperparathyroidism

Özet

Primary hyperparathyroidism (pHPT) is the third most frequently seen endocrine disease and it is the most common cause ofhypercalcemia seen in ambulatory patients. PHPT is most often (80%-85%) caused by a single parathyroid adenoma, followedby double adenoma (4%-5%), multiple gland hyperplasia (10%-15%), and parathyroid carcinoma (<1%). The diagnosis of pHPTis biochemically established and the only curative treatment is surgery. Since the cause of pHPT is typically single-gland disease,it is possible to determine the majority of pathological glands with preoperative localization methods and use the minimallyinvasive parathyroidectomy (MIP) approach. MIP has become the standard treatment for pHPT in selected patients. There areboth noninvasive and invasive preoperative localization methods. Noninvasive methods currently used include ultrasonography(US), parathyroid scintigraphy, 4-dimensional computed tomography (CT), magnetic resonance imaging, and positron emissiontomography-CT with 18F-fluoroquinolone and 11C-methionine. Preoperative invasive localization methods include parathyroidhormone (PTH) measurement with fine-needle aspiration biopsy, lateralization with PTH measurement via bilateral jugular veinsampling, selective venous sampling, and parathyroid arteriography. The aim of this study was to evaluate preoperative localization studies used in cases of pHPT.