Comparison of the clinical appearance, laboratory measures and scintigraphy data in patients with different types of primary and secondary hyperparathyroidism
The aim of the study is to assess the role of neck scintigraphy in comparison with the clinical and laboratory data in patients with different types of primary and secondary hyperparathyroidism (HPT).
Material and methods. The single-center retrospective study includes data of 138 consecutive patients with diagnosed primary or secondary HPT, who had the results of neck ultrasound and known laboratory levels of HPT markers, including 59 patients with hypercalcemic primary HPT (hPHPT), 15 - with normocalcemic HPT (nPHPT), 50 - with secondary HPT due to the acquired vitamin D deficiency, 14 - with terminal chronic kidney disease (CKD), referred to the Federal National Medical Research Center of Cardiology for performing scintigraphy and SPECT/CT of the neck and mediastinum with 99mTc-MIBI.
Results and discussion. Among 138 patients with HPT complaints were observed in 64.5%. In patients with PHPT bone pain and convulsions occurred more often (p=0.006 and 0.02, respectively). The maximum values of PTH, phosphorus and alkaline phosphatase were marked in patients with CKD, maximum levels of general and ionized calcium - with hPHPT. The lowest frequency of vitamin D deficiency was observed in patients with nPHPT. The sensitivity of SPECT/CT in identifying of impaired parathyroids was 98.3% at hPHPT and 93.3% at nPHPT. The frequency of parathyroid ectopia in PHPT was 24.3%, adenomas with rapid clearance - 43.2%. In patients with PHPT, intensity of 99mTc-MIBI accumulation in the impaired parathyroids correlated with the adenoma diameter according to CT data (p=0.01), correlated poorly with PTH level (p=0.12), correlated moderately with calcium level (p=0.08). In patients with acquired vitamin D deficiency, impaired parathyroids according to SPECT/CT were visualized in 8.0% of cases, in patients with CKD - at 14.3% of cases.
Conclusion. Neck SPECT/CT is the key method of detecting impaired parathyroids during preoperative preparation in patients with PHPT and SHPT caused by CKD. This modality may have a diagnostic value in treatment-resistant patients with vitamin D deficiency and upper-normal PTH and calcium levels in terms of detection of the nodular form of parathyroid hyperplasia.
Keywords:scintigraphy; single-photon emission tomography; hyperparathyroidism
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Prokina V.E., Ansheles A.A., Tarasov A.V., Volkov V.E., Ametov A.S., Sergienko V.B. Comparison of the clinical appearance, laboratory measures and scintigraphy data in patients with different types of primary and secondary hyperparathyroidism. Endokrinologiya: novosti, mneniya, obuchenie [Endocrinology: News, Opinions, Training]. 2022; 11 (1): 24-32. DOI: https://doi.org/10.33029/2304-9529-2022-11-1-24-32 (in Russian)
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