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Eric J. Bergson, MD; Laura A. Sznyter, MD; Sanford Dubner, MD; Christopher J. Palestro, MD; Keith S. Heller, MD

Arch Otolaryngol Head Neck Surg. 2004;130:87-91.

Objective  To assess the value of preoperative sestamibi scanning and intraoperative parathyroid hormone (IOPTH) measurement in the treatment of patients with primary hyperparathyroidism due to multiple gland disease (MGD).

Design  Retrospective medical record review.

Setting  Tertiary care academic medical center.

Patients  The study population comprised 383 consecutive patients who underwent surgery for primary hyperparathyroidism at Long Island Jewish Medical Center, New Hyde Park, NY, between June 1, 1999, and January 31, 2002.

Interventions  Sestamibi scanning, IOPTH measurement, bilateral parathyroid exploration, and minimally invasive parathyroid surgery.

Main Outcome Measures  Rate of postoperative persistent hyperparathyroidism.

Results  A total of 376 patients met the requirements for inclusion in the study. There were 275 women (73%) and 101 men (27%). Of the patients, 325 (86%) had single adenomas, 28 (7%) had double adenomas, 16 (4%) had 3 or more abnormal glands, and 1 had parathyroid cancer. There were 9 cases (2%) of persistent or recurrent hypercalcemia after surgery. Duration of follow-up ranged from 1 to 37 (median, 7) months. The sensitivity of sestamibi scanning for detecting MGD was 23%, and the positive predictive value was 63%. Using the requirement that the IOPTH level fall by 50% from the first baseline and into the normal range, MGD was distinguished from solitary adenoma in 36 (88%) of 41 cases.

Conclusions  The combination of preoperative sestamibi scanning and IOPTH measurement is effective in identifying cases of MGD and allows successful minimally invasive parathyroidectomy in most patients.

From the Department of Otolaryngology and Communicative Disorders (Dr Bergson), the Section of Head and Neck Surgery, Department of Surgery (Drs Sznyter, Dubner, and Heller), and the Division of Nuclear Medicine, Department of Radiology (Dr Palestro), Long Island Jewish Medical Center, the Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, NY. The authors have no relevant financial interest in this article.

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