Hypocalcemic stimulation and nonselective venous sampling for localizing parathyroid adenomas: work in progress.
OBJECTIVE
To evaluate whether the release of parathyroid hormone (PTH) from parathyroid tumors during selective parathyroid arteriography can help localize the tumors.


METHODS
In 20 patients (six men, 14 women; age range, 24-72 years) with parathyroid tumors undergoing parathyroid arteriography after failed surgery, serial measurements of PTH were obtained during selective arteriography with nonionic contrast material. PTH levels were measured in the superior vena cava (SVC) before and at varying times from 20 to 120 seconds after arteriography.


RESULTS
A 1.4-fold increase in the PTH level of the postarteriographic SVC samples enabled correct prediction of the site of adenoma in 13 of the 20 patients (65%). Of nine patients with positive arteriograms, eight had positive results of postarteriographic sampling. Of 11 patients with negative arteriograms, five had positive results of postarteriographic sampling.


CONCLUSIONS
Sampling the SVC for PTH gradients after selective parathyroid arteriography correctly indicated the site of the adenoma in 13 of 20 patients (65%).
Doppman
J L
JL
Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center, Bethesda, MD 20892-1182, USA.
Skarulis
M C
MC
Chang
R
R
Alexander
H R
HR
Bartlett
D
D
Libutti
S K
SK
Marx
S J
SJ
Spiegel
A M
AM
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000378:metabolism; D000328:Adult; D000368:Aged; D000792:Angiography; D001158:Arteries; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D003287:Contrast Media; D005260:Female; D005268:Femoral Vein; D005544:Forecasting; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood; D006996:Hypocalcemia / Q000097:blood; D007479:Iopamidol; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D010281:Parathyroid Hormone / Q000097:blood* / Q000378:metabolism; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism; D013961:Thyroid Gland / Q000098:blood supply; D013997:Time Factors; D014683:Vena Cava, Superior
D003287:Contrast Media; D010281:Parathyroid Hormone; D007479:Iopamidol