[New horizons for increased sensitivity of radionuclide imaging in primary hyperparathyroidism]

The aim of the study was to evaluate the impact of therapy with biphosphonates in patients with primary hyperparathyroidism and negative result of parathyroid scintigraphic imaging on increase of diagnostic sensitivity in repeated scans. Three female patients with diagnosed primary hyperparathyroidism and negative parathyroid imaging with subtraction 99m-Tc-MIBI scintigraphy were included into this prospective study. Patients had been receiving 70 mg of sodium alendronate orally, once a week for 3 months. After this period they were reevaluated with parathyroid subtraction scintigraphy. In all three patients a solitary area of uptake was found in the repeated scans. Patients were qualified for minimally invasive video-assisted parathyroidectomy. In two of them the repeated scans after treatment with biphosphonates were found to be true positive and in those two patients a solitary parathyroid adenoma was removed with video-assisted technique. In one patient a multiglandular disease was revealed intraoperatively basing on intraoperative iPTH assay and in that patient a subtotal video-assisted parathyroidectomy has been successfully completed. All three patients have been eucalcemic within the 6-months follow-up with iPTH serum values within the reference range. In conclusion, treatment with oral biphosphonates in patients with primary hyperparathyroidism and negative result of radionuclide parathyroid imaging, results in increased diagnostic sensitivity of repeated scans. This allows for successful minimally invasive parathyroid surgery in this group of patients with a predominant solitary parathyroid adenoma.