ABSTRACT
Bilateral neck exploration is the gold standard for parathyroid adenoma localization in primary hyperparathyroidism. But surgeons do not have adequate experience for accurate surgical exploration and new methods are developed for surgery like unilateral exploration and minimally invasive surgery, thus, preoperative localization could reduces time and stress in surgical performance. 80 patients with documented primary hyperparathyroidism and with raised serum calcium and parathyroid hormone [PTH] were selected. The results of ultrasonographic localization for each patient were compared with findings of surgery and 99m technetium sestamibi scintigraphy. Also variables such as preoperative serum calcium, PTH level and adenoma weight were compared between patients who had localized and nonlocalized adenoma with ultrasonography or Sestamibi scan. The data was compared with student's t-test. In a prospective diagnostic tests' accuracy, 80 patients with primary hyperparathyroidism were enrolled. Ultrasonography images detected enlarged parathyroid glands in 61 of 80 patients [76.3%] with sensitivity of 83.5% and positive predictive value [PPV] of 89.7%. Sestamibi scintigraphy detected adenoma in 63 patients [78.8%] with sensitivity of 85% and PPV of 91.3%. There was no significant deference between ultrasonography and scintigraphy in localization of adenomas. Both ultrasonography and scintigraphy used for determining localization, and they located 73 adenomas [91.3%] with sensitivity of 97.3% and PPV of 93.5%. Ultrasonography as an accurate method for localization of enlarged parathyroid glands in primary hyperparathyroidism, is comparable in overall utility with sestamibi scintigraphy. This study suggests a strategy for initial testing with one method, followed by the alternate imaging test if the first test happen to be negative
ABSTRACT
Primary hyperparathyroidism is autonomous production of parathyroid hormone. After removal of adenoma, one of the surgeons concern is postoperative hypocalcaemia. There is no precise method to determine if patients have hypocalcaemia postoperatively. The purpose of this study was to determine the relation between parathyroid adenoma weights, postoperative serum calcium and serum biochemical parameters in patients with primary hyperparathyroidism. In a prospective study, eighty patients with single parathyroid adenoma were enrolled. Preoperative serum levels of calcium, phosphate, PTH, as well as Postoperative serum calcium and weight of adenomas were recorded. The level of significance was set to be p < 0.05. There was no significant correlation between postoperative serum calcium, parathyroid adenoma weight [r= -0.17, p= 0.1], and parathyroid hormone level [r = -0.11, p = 0.3]. However, a weak correlation between postoperative and preoperative serum calcium levels [r = 0.23, p = 0.03] was observed. Moreover, Serum calcium decline after adenoma resection was statistically correlated with adenoma weight [r = 0.36, p= 0.001], preoperative serum calcium [r = 0.92, p- 0.0007], PTH [r- 0.54, p= 0.0005] and ALP levels [r = 0.3, p= 0.006]. Although preoperative serum markers and adenoma weight are unreliable in predicting postoperative serum calcium level, it is possible to estimate postoperative calcium decline by considering adenoma weight and preoperative serum biochemical parameters