Sonography for early diagnosis of enlarged parathyroid glands in patients with secondary hyperparathyroidism.

High-resolution sonography of the neck was performed in 207 patients undergoing renal dialysis to determine the usefulness of sonography in the evaluation of secondary hyperparathyroidism. The sonograms in 62 (30%) of the patients showed enlarged parathyroid glands, with an average of 2.3 glands per patient. Both the number and size of enlarged glands were increased in patients who had been receiving dialysis treatment for more than 6 years. Of the patients who had enlarged parathyroid glands on sonography, only 61% had bone pain, and only 63% had evidence of hyperparathyroidism on bone radiographs. Serum levels of amino-terminal parathormone were within normal limits in 26% of these patients. In 14 patients who underwent total parathyroidectomy, the accuracy of sonography for the detection of enlarged parathyroid glands was 77% (40/52 lesions). Sonography is a valuable technique for the detection of enlarged parathyroid glands in patients with secondary hyperparathyroidism associated with renal dialysis.