Selective parathyroid venous sampling in patients with complicated hyperparathyroidism

• Published in: European journal of endocrinology Vol. 155; no. 6; pp. 813 - 821
• Main Authors: Ogilvie, C M, Brown, P L, Matson, M, Dacie, J, Reznek, R H, Britton, K, Carpenter, R, Berney, D, Drake, W M, Jenkins, P J, Chew, S L, Monson, J P
• Format: Journal Article
• Language: English
• Published: Colchester European Society of Endocrinology 01.12.2006; Portland Press
• Subjects: Adult; Aged; Biological and medical sciences; Clinical Studies; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Humans; Hyperparathyroidism - diagnostic imaging; Hyperparathyroidism - pathology; Hyperparathyroidism - surgery; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Glands - blood supply; Parathyroid Glands - diagnostic imaging; Parathyroid Glands - pathology; Parathyroid Hormone - blood; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - pathology; Parathyroid Neoplasms - surgery; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Reoperation; Retrospective Studies; Technetium Tc 99m Sestamibi; Tomography, X-Ray Computed; Vena Cava, Superior; Vertebrates: endocrinology; Endocrinopathy; Human; Parathyroid diseases; Blood vessel; Samplings; Complication; Circulatory system; Vein; Endocrinology; Hyperparathyroidism
• ISSN: 0804-4643; 1479-683X
• DOI: 10.1530/eje.1.02304

Objective: The role of preoperative localisation of abnormal parathyroid glands remains controversial but is particularly relevant to the management of patients with recurrent or persistent hyperparathyroidism and familial syndromes. We report our experience of the use of selective parathyroid venous sampling (PVS) in the localisation of parathyroid disease in such patients. Design: We report a retrospective 10-year experience (n = 27) of the use of PVS in complicated primary hyperparathyroidism and contrast the use of PVS with neck ultrasound, magnetic resonance imaging (MRI), computed tomography (CT) and sestamibi imaging modalities. Results: In 14 out of 25 patients who underwent surgery PVS results were completely concordant with surgical and histological findings and 88% of patients achieved post-operative cure. Out of 13 patients referred after previous failed surgery, 12 underwent further surgery which was curative in 9. In total PVS yielded useful positive (n = 13) and/or negative information (n = 6) in 19 out of 25 patients undergoing surgery. Using histology as the gold standard, 59% of PVS studies were entirely consistent with histology, as compared with 39% of ultrasound scans, 36% of sestamibi scans and 17% of MRI/CT scans. Conclusions: PVS is a valuable adjunct to MRI/CT and sestamibi scanning in selected patients with complicated hyperparathyroidism when performed in an experienced unit.