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Correlation between biochemical features and outcomes of preoperative imaging (SPECT-CT and Ultrasound) in primary hyperparathyroidism.

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PRIMARY HYPERPARATHYROIDISM - STRATEGY FOR MULTIGLAND DISEASE IN THE ERA OF SPECT-CT.

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Multigland disease (MGD) in primary hyperparathyroidism is more common in younger patients and often presents with mild hypercalcemia. These patients have a higher persistence rate and are more likely to be SPECT-CT negative, benefiting from bilateral neck exploration.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Nuclear Medicine

Background:

  • Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
  • Multigland disease (MGD) presents unique diagnostic and surgical challenges compared to single gland adenoma (SGD).
  • Accurate preoperative localization is crucial for successful surgical outcomes in PHPT.

Purpose of the Study:

  • To re-evaluate clinical practice and surgical strategies for PHPT, focusing on patients with MGD.
  • To compare outcomes between patients with SGD and MGD.
  • To assess the utility of SPECT-CT in localizing parathyroid adenomas in MGD patients.

Main Methods:

  • Retrospective analysis of 121 PHPT patients undergoing surgery between 2010 and 2014.
  • All patients underwent SPECT-CT (Single Proton Emission Computerized Tomography) for localization.
  • Surgical outcomes, including cure rates and persistent disease, were analyzed.

Main Results:

  • MGD was identified in 13% of patients and was more prevalent in those under 40.
  • The overall cure rate was 95.86%. Patients with MGD had a higher persistence rate (13.33% vs. 2.83%).
  • SPECT-CT negative scans were more common in MGD patients (40% vs. 25.4%), often associated with mild hypercalcemia.

Conclusions:

  • MGD patients, particularly younger individuals, are more frequently SPECT-CT negative and have higher persistence rates.
  • Bilateral neck exploration (BNE) is recommended for young, SPECT-CT negative patients.
  • Minimally invasive parathyroidectomy with intraoperative PTH monitoring may be considered for selected cases based on imaging suggestive of a single large adenoma.