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Minerva Endocrinologica 2008 September;33(3):203-12

language: English

Localising imaging in secondary hyperparathyroidism

Fuster D. 1, Torregrosa J.-V. 2, Setoain X. 1, Doménech B. 1, Campistol J. M. 1, Rubello D. 3, Pons F. 1

1 Nuclear Medicine Department, Hospital Clínic Barcelona, Spain
2 Renal Transplant Unit, Hospital Clínic Barcelona, Spain
3 Unit of Nuclear Medicine, Rovigo General Hospital, Rovigo, Italy


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Preoperative
imaging has proved its use successful in the localization of solitary
parathyroid adenomas in patients with suspected primary
hyperparathyroidism. However, due to multiglandular disease at
presentation patients with renal hyperparathyroidism need to be
analyzed separately, making the usefulness of imaging techniques
controversial. Recently, improved methods of functional imaging like
parathyroid scan with 99mTc-sestamibi or positron emission tomography,
especially when combined with computed tomography, can provide
additional quantitative and qualitative information that has yet to be
assessed. Nuclear medicine procedures could prove useful not only in
preoperative diagnosis, but also in the selection of medical or
surgical therapeutic alternatives in secondary hyperparathyroidism
patients. There is evidence that 99mTc-sestamibi uptake in parathyroid
hyperplasia or adenoma is related to biochemical markers of parathyroid
function. We are only beginning to identify the factors involved in
radiotracer uptake by parathyroid cells and how it can be modulated to
obtain more accurate results. This review analyzes the current use of
non-invasive imaging modalities in patients with secondary
hyperparathyroidism, taking into account the latest trends in the field
combining anatomic and functional modalities and the relevant factors
linked to radiotracer uptake in abnormal hyperfunctioning parathyroid
glands.

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