Sestamibi scans and intraoperative parathyroid hormone measurement in the treatment of primary hyperparathyroidism.
OBJECTIVE
To assess the value of preoperative sestamibi scanning and intraoperative parathyroid hormone (IOPTH) measurement in the treatment of patients with primary hyperparathyroidism due to multiple gland disease (MGD).


METHODS
Retrospective medical record review.


METHODS
Tertiary care academic medical center.


METHODS
The study population comprised 383 consecutive patients who underwent surgery for primary hyperparathyroidism at Long Island Jewish Medical Center, New Hyde Park, NY, between June 1, 1999, and January 31, 2002.


METHODS
Sestamibi scanning, IOPTH measurement, bilateral parathyroid exploration, and minimally invasive parathyroid surgery.


METHODS
Rate of postoperative persistent hyperparathyroidism.


RESULTS
A total of 376 patients met the requirements for inclusion in the study. There were 275 women (73%) and 101 men (27%). Of the patients, 325 (86%) had single adenomas, 28 (7%) had double adenomas, 16 (4%) had 3 or more abnormal glands, and 1 had parathyroid cancer. There were 9 cases (2%) of persistent or recurrent hypercalcemia after surgery. Duration of follow-up ranged from 1 to 37 (median, 7) months. The sensitivity of sestamibi scanning for detecting MGD was 23%, and the positive predictive value was 63%. Using the requirement that the IOPTH level fall by 50% from the first baseline and into the normal range, MGD was distinguished from solitary adenoma in 36 (88%) of 41 cases.


CONCLUSIONS
The combination of preoperative sestamibi scanning and IOPTH measurement is effective in identifying cases of MGD and allows successful minimally invasive parathyroidectomy in most patients.
Bergson
Eric J
EJ
Department of Otolaryngology and Communicative Disorders, Long Island Jewish Medical Center, the Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, NY, USA.
Sznyter
Laura A
LA
Dubner
Sanford
S
Palestro
Christopher J
CJ
Heller
Keith S
KS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi