Rehman Habib U, Krishnasamy SenthilKumar, Rabbi Jamal, Qadir Mamoon, Rafique Yasmeen, Mian Fahd, Yousuf Quratulain
General Medicine, Endocrinology, Kulsum International Hospital, Islamabad, PAK.
Endocrinology, Diabetes and Metabolism, Walsall Manor Hospital, Walsall, GBR.
Cureus. 2020 Aug 31;12(8):e10155. doi: 10.7759/cureus.10155.
Introduction Primary hyperparathyroidism is a common endocrine condition requiring parathyroidectomy for curative management. Localization of parathyroid gland by ultrasound and Tc99m-SESTAMIBI is important to opt for less invasive and comparatively lower complication risk surgery minimal invasive parathyroidectomy (MIP) instead of four-gland exploration surgery. Aim To evaluate ultrasound and Tc99m-SESTAMIBI in localization of abnormal parathyroid gland before surgery. Method and materials All patients of primary hyperparathyroidism (PHPT) that presented to a secondary care hospital (endocrinology department) from 2015-2019 were recruited retrospectively from electronic fusion system of hospital. Results of ultrasound parathyroid and Tc99m-SESTAMIBI done for localization of abnormal parathyroid gland were analyzed. Results Total PHPT patients recruited were 59, mean age 64.2 years, male 11 (18.64%) and female 48 (81.3%). Ultrasound parathyroid was done in 44 patients, Tc 99m-SESTAMIBI was done in 31, both tests were done in 31 patients. Combined concordant adenoma in both tests was seen in 11 (35%) cases which can opt for minimal invasive parathyroidectomy (MIP) with confidence whereas 65% of cases would require either four-gland exploration or further testing like single-photon emission computed tomography-computed tomography (SPECT-CT) or intraoperative parathyroid hormone measurement to opt for MIP. Conclusion Combined ultrasound parathyroid and Tc 99m-SESTAMIBI scan was useful in localization of parathyroid adenoma in 11 (35%) patients that can opt for MIP which is a lower complication risk surgery whereas 20 (65%) patients would need further investigation with SPECT-CT or intraoperative parathyroid hormone measurement or four-gland exploration surgery. Recommendation Third modality of investigation such as SPECT-CT or intraoperative parathyroid hormone measurement needs evaluation so that more patients can benefit from MIP instead of four-gland exploration surgery.
引言
原发性甲状旁腺功能亢进是一种常见的内分泌疾病，需要进行甲状旁腺切除术以达到治愈目的。通过超声和锝-99m甲氧基异丁基异腈（Tc99m-SESTAMIBI）对甲状旁腺进行定位，对于选择侵入性较小且并发症风险相对较低的手术——微创甲状旁腺切除术（MIP）而非双侧探查手术至关重要。
目的
评估超声和Tc99m-SESTAMIBI在术前对异常甲状旁腺的定位情况。
方法和材料
对2015年至2019年在一家二级医院（内分泌科）就诊的所有原发性甲状旁腺功能亢进症（PHPT）患者，从医院的电子融合系统中进行回顾性招募。分析超声甲状旁腺检查和用于异常甲状旁腺定位的Tc99m-SESTAMIBI检查结果。
结果
共招募了59例PHPT患者，平均年龄64.2岁，男性11例（18.64%），女性48例（81.3%）。44例患者进行了超声甲状旁腺检查，31例进行了Tc99m-SESTAMIBI检查，31例患者两项检查均做了。两项检查中联合一致的腺瘤在11例（35%）患者中可见，这些患者可以放心地选择微创甲状旁腺切除术（MIP），而65%的患者需要进行双侧探查或进一步检查，如单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）或术中甲状旁腺激素测量，以选择MIP。
结论
联合超声甲状旁腺检查和Tc99m-SESTAMIBI扫描对11例（35%）可选择MIP（一种并发症风险较低的手术）的甲状旁腺腺瘤患者的定位有用，而20例（65%）患者需要通过SPECT-CT或术中甲状旁腺激素测量或双侧探查手术进行进一步检查。
建议
需要评估诸如SPECT-CT或术中甲状旁腺激素测量等第三种检查方式，以便更多患者能够从MIP中受益，而非双侧探查手术。
