Parathyroid scintigraphy findings in chronic kidney disease patients with recurrent hyperparathyroidism

  • Elif Hindié
  • Paolo Zanotti-Fregonara
  • Pierre-Alexandre Just
  • Emile Sarfati
  • Didier Mellière
  • Marie-Elisabeth Toubert
  • Jean-Luc Moretti
  • Christian Jeanguillaume
  • Isabelle Keller
  • Pablo Ureña-Torres
Original Article

Abstract

Background

Parathyroidectomy (PTX), either subtotal or total with forearm autografting, is a well-established treatment for refractory renal hyperparathyroidism (RHPT). However, 20–30% of patients develop persistent or recurrent disease. Obtaining accurate localization before reoperation is difficult.

Patients and methods

The study group comprised 21 consecutive adult patients (18 undergoing haemodialysis and 3 with a renal graft) imaged using 99mTc-sestamibi/123I subtraction scintigraphy. Of the 21 patients, 12 had undergone one previous PTX and the other 9 between two and four parathyroid operations. All patients had symptoms and signs of severe RHPT. The mean serum PTH level was 1,142 pg/ml. 99mTc-Sestamibi and 123I images were recorded simultaneously. Imaging views comprised a planar view of the neck and mediastinum, followed by a magnified pinhole view over the thyroid bed area. If parathyroid ectopy was detected, SPECT or SPECT-CT was performed. The forearm was imaged in case of autograft.

Results

Parathyroid scintigraphy was negative in one patient and positive in the other 20 (sensitivity 95.2%). One patient had uptake corresponding to two unresected parathyroid glands. Recurrence at the site of the partially resected gland or autograft was seen in 11 patients. However, six of them had a second 99mTc-sestamibi focus corresponding to a supernumerary parathyroid gland. Seven other patients had a supernumerary parathyroid gland as the sole cause of relapse. Three of the supernumerary glands showed major ectopy (intrathyroidal, low mediastinal, undescended within the vagus nerve). One patient had parathyromatosis with multiple parathyroid nodules scattered over the left side of the neck. Reoperation was possible in 13 patients, with no false-positive findings.

Conclusion

Many patients referred with the hypothesis of hyperplasia of a subtotally resected parathyroid gland or autograft were found to harbour a supernumerary parathyroid gland missed at the initial surgery.

Keywords

Secondary hyperparathyroidism CKD Sestamibi scanning Subtraction scanning Surgery Parathyroidectomy Recurrent Reoperative surgery Parathyroid scintigraphy Imaging studies 

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Elif Hindié
    • 1
    • 7
  • Paolo Zanotti-Fregonara
    • 2
  • Pierre-Alexandre Just
    • 1
  • Emile Sarfati
    • 3
  • Didier Mellière
    • 4
  • Marie-Elisabeth Toubert
    • 1
  • Jean-Luc Moretti
    • 1
  • Christian Jeanguillaume
    • 5
  • Isabelle Keller
    • 2
  • Pablo Ureña-Torres
    • 6
  1. 1.Nuclear Medicine, Hôpital Saint LouisUniversité Paris 7ParisFrance
  2. 2.Nuclear Medicine, Hôpital Saint AntoineUniversité Paris VIParisFrance
  3. 3.Endocrine Surgery, Hôpital Saint LouisUniversité Paris 7ParisFrance
  4. 4.Endocrine Surgery, Hôpital Henri MondorUniversité Paris XIICréteilFrance
  5. 5.Centre Paul PapinUniversité d’AngersAngersFrance
  6. 6.Service de Néphrologie-DialyseClinique du LandySaint OuenFrance
  7. 7.Service de Médecine NucléaireHôpital Saint-LouisParisFrance

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