Primary Hyperparathyroidism: A Case Series, Patient-Centered Approach to Diagnosis and Management Review

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Primary hyperparathyroidism (pHPT) is a common endocrine disorder characterized by excessive parathyroid hormone (PTH) secretion, leading to calcium imbalances and potential complications.
• Diagnosis often occurs incidentally through blood tests, though symptomatic cases involve parathyroid gland dysfunction.
• Surgery is the primary curative treatment for pHPT, benefiting both symptomatic and asymptomatic individuals.

Purpose of the Study:

• To present a series of 6 complex primary hyperparathyroidism cases requiring specialized management.
• To highlight the challenges posed by atypical presentations, rare adenoma locations, and specific patient conditions.

Main Methods:

• Case series approach detailing management strategies for diverse pHPT presentations.
• Utilized diagnostic imaging including ultrasound, Tc-99m sestamibi scintigraphy, SPECT/CT, and 18F-FCH PET/CT.
• Employed intraoperative parathyroid hormone monitoring for complex cases, particularly hereditary forms.

Main Results:

• Successfully managed varied cases including parathyroid carcinoma, mediastinal and intrathymic adenomas, recurrent pHPT, and hereditary pHPT in MEN 1.
• Demonstrated the efficacy of combined ultrasound and scintigraphy for adenoma localization.
• Highlighted the utility of advanced imaging and intraoperative PTH monitoring in challenging scenarios.

Conclusions:

• Complex pHPT cases necessitate a multidisciplinary approach due to varied presentations and diagnostic/therapeutic uncertainties.
• Surgeon expertise is paramount for achieving safe and effective surgical outcomes in pHPT.
• Advanced imaging and intraoperative monitoring aid in managing difficult and recurrent cases.