Balci G, Bahçecioğlu A B, Avcı Merdin F, Erdoğan M F
Department of Internal Medicine, Ankara University, School of Medicine, Ankara, Turkey.
Department of Endocrinology and Metabolism, Ankara University, School of Medicine, Ankara, Turkey.
Acta Endocrinol (Buchar). 2024 Jul-Sep;20(3):311-317. doi: 10.4183/aeb.2024.311. Epub 2025 May 23.
Primary hyperparathyroidism (PHP) is a prevalent endocrine disorder requiring surgical treatment. The rise of minimally invasive parathyroidectomy as the favored surgical approach emphasizes the significance of localization studies. This study aims to explore clinical and laboratory profiles of PHP patients and evaluate the efficacy of diverse localization methods in a substantial patient cohort.
We analyzed clinical features, biochemical parameters, and imaging outcomes for localization, as well as postoperative histopathological findings in 327 diagnosed PHP patients who underwent surgery. Initial localization methods, which included ultrasonography (US), US-guided Parathormone (PTH) washout analysis, and 99mTechnetium-Sestamibi/123Iodine Scintigraphy (MIBI-SPECT/CT), were applied to all patients. Advanced techniques like Four-Dimensional Computed Tomography (4D-CT) and 18F-Fluorocholine Positron Emission Tomography (18F-FCH PET/CT) were used for cases where initial methods failed and/or for secondary intervention.
Minimally invasive surgery accounted for 74% (n=241) of cases. Histopathological analysis revealed single adenoma in 94.5% (n=309) patients, hyperplasia in 5.2% (n=17), and cancer in 0.3% (n=1). Adenoma volume showed a significant positive correlation with serum calcium and parathyroid hormone (PTH) levels (p<0.001). 82 and 26 cases required 4D-CT and 18F-FCH PET/CT respectively, for localization. Positive predictive values (PPV) for imaging modalities were: US (84.56%), US-guided PTH-washout analysis (87.30%), MIBI-SPECT/CT (92.1%), 4D-CT (81.94%), and 18F-FCH PET/CT (95.83%).
Serum calcium and PTH levels estimate adenoma size. Initial localization studies (i.e.US, PTH washout and, MIBI-SPECT/CT) effectively localized most adenomas. 4D-CT showed notable efficacy, and 18F-FCH PET/CT had the highest PPV for adenoma localization when the initial studies failed.
原发性甲状旁腺功能亢进症（PHP）是一种需要手术治疗的常见内分泌疾病。微创甲状旁腺切除术作为首选手术方法的兴起凸显了定位研究的重要性。本研究旨在探讨PHP患者的临床和实验室特征，并评估多种定位方法在大量患者队列中的疗效。
我们分析了327例接受手术的确诊PHP患者的临床特征、生化参数、定位影像学结果以及术后组织病理学发现。所有患者均采用了包括超声检查（US）、超声引导下甲状旁腺激素（PTH）洗脱分析以及99m锝-甲氧基异丁基异腈/123碘闪烁扫描（MIBI-SPECT/CT）在内的初始定位方法。对于初始方法失败和/或需要二次干预的病例，则使用四维计算机断层扫描（4D-CT）和18F-氟胆碱正电子发射断层扫描（18F-FCH PET/CT）等先进技术。
微创手术占病例的74%（n=241）。组织病理学分析显示，94.5%（n=309）的患者为单发腺瘤，5.2%（n=17）为增生，0.3%（n=1）为癌症。腺瘤体积与血清钙和甲状旁腺激素（PTH）水平呈显著正相关（p<0.001）。分别有82例和26例需要4D-CT和18F-FCH PET/CT进行定位。各影像学检查方法的阳性预测值（PPV）分别为：US（84.56%）、超声引导下PTH洗脱分析（87.30%）、MIBI-SPECT/CT（92.1%）、4D-CT（81.94%）和18F-FCH PET/CT（95.83%）。
血清钙和PTH水平可估计腺瘤大小。初始定位研究（即US检查、PTH洗脱分析和MIBI-SPECT/CT）能有效定位大多数腺瘤。4D-CT显示出显著疗效，而当初始研究失败时，18F-FCH PET/CT在腺瘤定位方面具有最高的PPV。
