title: Hyperparathyroidism but a negative sestamibi scan: a clinical dilemma.
abstract: BACKGROUND
  The outcomes of patients with biochemically confirmed hyperparathyroidism but a negative Tc-99 Sestamibi scan are unclear. We examined the outcomes and quality of life of patients having surgery and those who had medical therapy.
  
  
  METHODS
  Patients having a diagnosis of hyperparathyroidism with confirmed elevated calcium and parathormone levels, yet negative sestamibi scans were identified. The RAND SF-36 Health Survey was administered via mail to these patients. The patient's charts were then reviewed to verify treatments and to determine outcomes.
  
  
  RESULTS
  Ninety-five patients fitting the criteria were identified. Twenty patients completed all aspects of the study. Ten of the respondents had undergone parathyroidectomy, and 10 had not. The surgical patients scored more favorably in all 8 of the measured parameters than patients treated medically. The differences in 3 domains, physical functioning, pain, and social functioning, were statistically significant.
  
  
  CONCLUSIONS
  Our findings suggest that surgical therapy confers a better quality of life and is superior to medical therapy in the treatment of primary hyperparathyroidism, even in patients having a negative sestamibi scan.
authors.affiliation: Department of Surgery, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3955, USA.
authors.forename: Gavin T
authors.initials: GT
authors.lastname: Slitt
authors.forename: Hugh
authors.initials: H
authors.lastname: Lavery
authors.forename: Anthony
authors.initials: A
authors.lastname: Morgan
authors.forename: Bruce
authors.initials: B
authors.lastname: Bernstein
authors.forename: James
authors.initials: J
authors.lastname: Slavin
authors.forename: Mozaferiddin K
authors.initials: MK
authors.lastname: Karimeddini
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kozol
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D003657:Decision Making; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D011788:Quality of Life; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017256:Technetium Tc 99m Sestamibi; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium