Motivation for Imaging Studies

Abstract

Minimally invasive parathyroidectomy guided by noninvasive localization studies has become the standard surgical approach to primary hyperparathyroidism. About 80% of the time, primary hyperparathyroidism is due to a solitary parathyroid adenoma, so accurate identification on screening studies will usually result in the desired limited surgery, verified by a drop of intraoperative parathormone level. The limited surgery may be converted to a four-gland exploration if the intraoperative parathormone does not drop. Four-gland exploration will be planned if multigland disease is diagnosed (or highly suspect) or if all studies are negative. If a mediastinal adenoma is diagnosed and no enlarged parathyroid gland is identified in the neck, mediastinal surgery is performed before a neck exploration. Ultrasound, sestamibi scan, contrast CT scan, and MRI are the noninvasive modalities available to find the starting point in evaluating patients with clinically diagnosed primary hyperparathyroidism.