Treatment with oral biphosphonates can increase the sensitivity of sestamibi radionuclide imaging in patients with primary hyperparathyroidism.
The sensitivity of 99mTc-sestamibi scan in detecting parathyroid disease in primary hyperparathyroidism (PHP) is almost 90%, and therefore facilitates successful parathyroidectomy. To enhance the diagnostic accuracy of the procedure, we repeated imaging with 99mTc-sestamibi in 15 patients with PHP and an initially negative (11 patients) or weakly positive (four patients) 99mTc-sestamibi scan after the administration of 10 mg of oral alendronate for 2 months. Serum calcium, phosphate and parathormone (PTH) measurements were obtained at presentation and after 1 and 2 months' treatment with alendronate. Eight patients with an initially negative 99mTc-sestamibi scan demonstrated at least one area of uptake in the repeated scan. Six of these patients underwent surgery and obtained a biochemical cure; a single adenoma was found in four and hyperplasia in the remaining two. In all four patients with an initially weakly positive 99mTc-sestamibi scan, the repeated scan demonstrated enhanced uptake and also revealed further areas of uptake. Two of these patients underwent surgery with a biochemical cure; an adenoma was found in one and hyperplasia in another. Compared with baseline there was a significant increase in PTH but not in calcium or phosphate levels during treatment with alendronate. We suggest that, in patients with PHP and a negative or weakly positive initial 99mTc-sestamibi scan, administration of oral alendronate may be associated with a positive repeated 99mTc-sestamibi scan and can thus enhance the sensitivity of the procedure.
Makras
P
P
Department of Endocrinology and Metabolism, "G Gennimatas" General Hospital, Athens, Greece.
Kaltsas
G A
GA
Athanasoulis
T
T
Papadogias
D
D
Zografos
G N
GN
Kontogeorgos
G
G
Borboli
N
N
Piaditis
G
G
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000368:Aged; D019386:Alendronate / Q000494:pharmacology*; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010280:Parathyroid Glands / Q000187:drug effects / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy; D010710:Phosphates / Q000097:blood; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
D010281:Parathyroid Hormone; D010710:Phosphates; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium; D019386:Alendronate