Sestamibi scans and intraoperative parathyroid hormone measurement in the treatment of primary hyperparathyroidism.

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.