Comparative utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism

• Published in: The American journal of surgery 2023-02, Vol.225 (2), p.293-297
• Main Authors: Montgomery, Kelsey B., Gillis, Andrea, Ramonell, Kimberly M., Fazendin, Jessica M., Lindeman, Brenessa, Chen, Herbert
• Format: Article
• Language: English
• Subjects: Accuracy; Calcium; Complications; Equivalence; Humans; Hypercalcemia; Hypercalcemia - complications; Hyperparathyroidism; Hyperparathyroidism, Primary - complications; Hyperparathyroidism, Primary - diagnostic imaging; Hyperparathyroidism, Primary - surgery; Hyperplasia; Hypocalcemia; Imaging; Laboratories; Localization; Normocalcemic; Parathyroid Hormone; Parathyroidectomy; Patients; Postoperative; Primary hyperparathyroidism; Retrospective Studies; Statistical analysis; Surgeons; Surgery; Surgical outcomes; Thyroid gland; Tumors; Ultrasonic imaging
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2022.09.042

Normocalcemic primary hyperparathyroidism (PHPT) has been shown to benefit from parathyroidectomy. PHPT may be localized preoperatively with various imaging modalities, but the utility of preoperative imaging in normocalcemic PHPT compared to hypercalcemic PHPT is not well defined. Retrospective review was performed on all PHPT patients who underwent parathyroidectomy from 2001 to 2019. Patients were stratified into normocalcemic and hypercalcemic groups. Patient and outcomes data were analyzed. All 2218 patients in this database were included. 433 patients had normocalcemic PHPT (19.5%) and 1785 had hypercalcemic PHPT (80.5%). Among normocalcemic patients, equivalent cure rates were seen between patients with preoperative imaging versus those without (100% vs 99%). No differences in postoperative complications were demonstrated except for a slightly increase in transient hypocalcemia in patients without imaging. Normocalcemic PHPT patients had equivalent cure and similar complication rates with or without preoperative imaging compared to hypercalcemic patients. Routine localization studies in normocalcemic PHPT may be safely omitted in favor of exploration with intraoperative adjuncts by experienced surgeons. •Normocalcemic primary hyperparathyroidism has higher rates of nonlocalizing disease.•In this population, preoperative localization studies may be less useful.•Equivalent cure rates were seen for normocalcemic patients with and without imaging.•Preoperative imaging in normocalcemic PHPT may be safely omitted.