Nuclear imaging and minimally invasive surgery in the management of hyperparathyroidism

Abstract

Primary hyperparathyroidism is the most common cause of hypercalcemia, and the treatment is primarily surgical. Because of biochemical screening, more patients now present with asymptomatic primary hyperparathyroidism, and consensus guidelines have been developed for the treatment of these patients. There is now considerable interest in minimally invasive approaches to the treatment of hyperparathyroidism. Sestamibi scanning as a localizing study, used in combination with anatomic imaging and intraoperative rapid parathyroid hormone assays, has enabled focused surgical approaches. Patients with localizing studies that indicate a single parathyroid adenoma are candidates for such approaches, including unilateral neck exploration, minimally invasive single-gland exploration, or endoscopic exploration instead of the traditional approach of bilateral neck exploration. Nuclear imaging is also critical to the successful management of patients with persistent or recurrent hyperparathyroidism.

FIGURE 1

Image after administration of sestamibi (2-h delay on left window) demonstrates right inferior parathyroid adenoma.

FIGURE 2

T2-weighted MR image demonstrates parathyroid adenoma in left tracheoesophageal groove.

FIGURE 3

Management schema for primary hyperparathyroidism.

FIGURE 4

Multidisciplinary team approach in treatment of hyperparathyroidism. (Adapted from Shaha (6).)