Chapter 10: What parathyroid imaging is required for hyperparathyroidism?

Charlotte Lussey-Lepoutre, Sébastien Gaujoux, Jean-Christophe Lifante, Benjamin Chevalier, Françoise Borson-Chazot, Camille Buffet, Miriam Ladsous, Luigi Maione, Delphine Drui, David Taieb, Cécile Ghander

Journal: Annales d'endocrinologie 2025;86(1):101699

PMID: 39818294

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Abstract

In over 80% of cases, primary hyperparathyroidism results from hypersecretion of PTH by a single parathyroid adenoma. Multi-glandular involvement, combining adenoma and/or hyperplasia in varying proportions, is also possible, although less frequent. When the diagnosis of hyperparathyroidism is certain and surgery is envisaged, imaging is useful for locating the hyperfunctioning gland or glands. First-line exploration is based on a parathyroid ultrasound and a nuclear medicine examination, which may be parathyroid scintigraphy, preferably double isotope I/ Tc-sestamibi, with planar and tomoscintigraphic acquisitions, or a PET-CT scan with F-choline. In the event of negative results, it is advisable to perform a choline PET scan if the initial examination was scintigraphy. In difficult situations, additional investigations using 4D parathyroid CT or parathyroid MRI, fine-needle aspiration cytology and determination of PTH in the flushing fluid are possible after multidisciplinary discussion in an expert center.

Address: Service de médecine nucléaire et imagerie fonctionnelle, hôpital Claude-Huriez, CHRU et université de Lille, Lille, France. Electronic address: [email protected].; Service des pathologies thyroïdiennes et tumorales endocrines, hôpital de la Pitié-Salpêtrière, AP-HP, 47-83, Boulevard de l'Hôpital, 75651 Paris cedex, France. Electronic address: [email protected].; Service d'endocrinologie, diabétologie, métabolisme et nutrition, hôpital Claude-Huriez, CHU de Lille, 59000 Lille, France. Electronic address: [email protected].; Département de chirurgie viscérale et endocrinienne, hôpital de la Pitié-Salpêtrière, AP-HP, Sorbonne université, 47-83, boulevard de l'Hôpital, 75651 Paris cedex, France. Electronic address: [email protected].; Département de médecine nucléaire, hôpital de la Timone, AP-HM, CERIMED, université Aix-Marseille, 264, rue Saint-Pierre, 13385 Marseille, France. Electronic address: [email protected].; Service des pathologies thyroïdiennes et tumorales endocrines, institut universitaire du cancer (IUC), hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, Inserm U1146, CNRS UMR 737, Paris, France. Electronic address: [email protected].; Service d'endocrinologie, diabétologie et nutrition, institut du Thorax, CHU de Nantes, Nantes université, 44000 Nantes, France. Electronic address: [email protected].; Département de chirurgie endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, université Lyon 1, chemin du Grand Revoyet, 69450 Pierre Bénite, France. Electronic address: [email protected].; Service endocrinologie adultes et maladies de la reproduction, hôpital de Bicêtre, AP-HP, université Paris-Saclay, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France. Electronic address: [email protected].; Departement de médecine nucléaire, groupe hospitalier Pitié-Salpêtrière, université de Sorbonne, Paris, France. Electronic address: [email protected].; Federation d'endocrinologie, hopital Louis Pradel, hospices civils de Lyon, université Lyon 1, 28, avenue Doyen-Lépine, 69500 Bron, France. Electronic address: [email protected].

DOI: 10.1016/j.ando.2025.101699

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MeSH Terms: Humans, Adenoma, Hyperparathyroidism, Hyperparathyroidism, Primary, Parathyroid Glands, Parathyroid Neoplasms, Radionuclide Imaging, Ultrasonography