Localization of hyperfunctioning parathyroid glands by selective venous sampling in reoperation for primary or secondary hyperparathyroidism.
BACKGROUND
Localization of hyperfunctioning parathyroid glands in patients with previous cervical operations is not always successful with noninvasive methods such as ultrasound, sestamibi scan, or magnetic resonance imaging. The aim of our study was to evaluate the results of selective venous sampling (SVS) of intact parathyroid hormone (PTH) in patients undergoing surgery for primary (75%) or secondary (25%) hyperparathyroidism (HPT).


METHODS
Between January 2000 and January 2006, SVS for PTH was performed in 51 consecutive patients with persistent or recurrent HPT or patients with previous cervical explorations. The results of SVS were compared with those of noninvasive localization studies.


RESULTS
Successful surgical treatment was achieved in 47 of 51 patients (92%). SVS had a sensitivity of 83.3% for the correct localization of a parathyroid adenoma (79.5%) or hyperplastic parathyroid glands (91.6%). False-positive or indeterminate results of SVS were found in 6% and 2%, respectively, of the patients. Ultrasound detected enlarged parathyroid glands with a sensitivity of 33.3%, and sestamibi scan with a sensitivity of 57.1%.


CONCLUSIONS
Compared with noninvasive localization studies, SVS for PTH yielded the best results for recurrent or persistent HPT and for patients with previous neck explorations. SVS is strongly recommended in reoperative surgery for HPT with indeterminate results of noninvasive methods.
Reidel
Margot A
MA
Department of Surgery, University of Heidelberg, Medical School, Germany. Margot_Reidel@med.uni-heidelberg.de
Schilling
Tobias
T
Graf
Stefanie
S
Hinz
Ulf
U
Nawroth
Peter
P
Büchler
Markus W
MW
Weber
Theresia
T
D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D010281:Parathyroid Hormone / Q000097:blood*; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000379:methods; D012086:Reoperation; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi