Primary Hyperparathyroidism

  • Jukka Schildt
  • Virpi Tunninen
  • Marko Seppänen
  • Camilla Schalin-JänttiEmail author


Primary hyperparathyroidism (PHPT) is a common endocrine disorder that especially affects women over 50–60 years [1]. The combination of increased serum calcium and parathyroid hormone (PTH) concentrations confirms the diagnosis. Surgery is the only potentially curative treatment, and there is universal agreement regarding which patients should be referred for surgery and for whom surveillance is sufficient. If the patient is scheduled for surgery, preoperative localization of the abnormal parathyroid gland(s) should be performed in order to help the surgeon plan the surgical strategy. It has been estimated that 60–70 % of patients with PHPT are candidates for unilateral neck exploration. If surgery is not planned, there is no reason to perform preoperative localization studies. Preoperative localization studies are mandatory before reoperation of PHPT. Multiple localization studies are to date available and they can be divided into invasive and noninvasive techniques. Surgery should not be ruled out based on a negative preoperative imaging study. For such cases, bilateral neck exploration is performed as primary surgery.


Hyperparathyroidism Imaging Parathyroid Ultrasound, scintigraphy, PET 


  1. 1.
    Pallan S, Rahman MO, Khan AA (2012) Diagnosis and management of primary hyperparathyroidism. BMJ 344:e1013CrossRefPubMedGoogle Scholar
  2. 2.
    Adami S, Marcocci C, Gatti D (2002) Epidemiology of primary hyperparathyroidism in Europe. J Bone Mineral Res 17(suppl 2):N18–23Google Scholar
  3. 3.
    Eastell R, Brandi ML, Costa AG et al (2014) Diagnosis of asymptomatic primary hyperparathyroidism: proceedings of the fourth International workshop. J Clin Endocrinol Metab 99:3570–3579CrossRefPubMedGoogle Scholar
  4. 4.
    Korpi-Hyövälti E, Cranston T, Ryhänen E et al (2014) CDC73 intragenic deletion in familial primary hyperparathyroidism associated with parathyroid carcinoma. J Clin Endocrinol Metab 99:3044–3048PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Lassen T, Friis-Hansen L, Rasmussen ÅK et al (2014) Primary hyperparathyroidism in young people. When should we perform genetic testing for multiple endokrine neoplasia 1 (MEN-1)? J Clin Endocrinol Metab 99:3983–3987CrossRefPubMedGoogle Scholar
  6. 6.
    Udelsman R, Åkerström G, Biagini C et al (2014) The surgical management of asymptomatic primary hyperparathyroidism: proceedings of the fourth International workshop. J Clin Endocrinol Metab 99:3595–3606CrossRefPubMedGoogle Scholar
  7. 7.
    Khan A, Bilezikian J (2000) Primary hyperparathyroidism: pathophysiology and impact on bone. CMAJ 163:184–187PubMedCentralPubMedGoogle Scholar
  8. 8.
    Khan AA, Bilezikian JP, Potts JT Jr (2009) The diagnosis and management of asymptomatic primary hyperparathyroidism revisited. J Clin Endocrinol Metab 94:333–334CrossRefPubMedGoogle Scholar
  9. 9.
    Bilezikian JP, Brandi ML, Eastell R et al (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab 99:3561–3569CrossRefPubMedGoogle Scholar
  10. 10.
    Ryhänen EM, Schildt J, Heiskanen I et al (2015) 99mTechnetium sestamibi-123Iodine scintigraphy is more accurate than 99mTechnetium sestamibi alone before surgery for primary hyperparathyroidism. Int J Mol Imaging 2015:391625Google Scholar
  11. 11.
    Schalin-Jäntti C, Ryhänen E, Heiskanen I et al (2013) Planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT/CT, 11C-methionine PET/CT, or selective venous sampling before reoperation of primary hyperparathyroidism? J Nucl Med 54:739–747CrossRefPubMedGoogle Scholar
  12. 12.
    Cheung K, Wang TS, Farrokhyar F et al (2012) A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol 19:577–583CrossRefPubMedGoogle Scholar
  13. 13.
    Reitz RE, Pollard JJ, Wang CA et al (1969) Localization of parathyroid adenomas by selective venous catheterization and radioimmunoassay. N Engl J Med 281:348–351CrossRefPubMedGoogle Scholar
  14. 14.
    Granberg PO, Hamberger B, Johansson G et al (1986) Selective venous sampling for localization of hyperfunctioning parathyroid glands. Br J Surg 73:118–120CrossRefPubMedGoogle Scholar
  15. 15.
    Coakley AJ, Kettle AG, Wells CP et al (1989) 99Tcm sestamibi – a new agent for parathyroid imaging. Nucl Med Commun 10:791–794CrossRefPubMedGoogle Scholar
  16. 16.
    Greenspan BS, Dillehay G, Intenzo C et al (2012) SNM practice guideline for parathyroid scintigraphy. J Nucl Med Technol 40:111–118CrossRefPubMedGoogle Scholar
  17. 17.
    Hindie E, Ugur Ö, Fuster D et al (2009) 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging 36:1201–1216CrossRefPubMedGoogle Scholar
  18. 18.
    Neumann DR, Esselstyn CB Jr, Go RT et al (1997) Comparison of double-phase 99mTc-sestamibi subtraction SPECT in hyperparathyroidism. AJR Am J Roentgenol 169:1671–1674CrossRefPubMedGoogle Scholar
  19. 19.
    Lavely WC, Goetze S, Firedman KP et al (2007) Comparison of SPECT/CT, SPECT and planar imaging with single- and dual-phase 99mTc-sestamibi scintigraphy. J Nucl Med 48:1084–1089CrossRefPubMedGoogle Scholar
  20. 20.
    Tunninen V, Varjo P, Schildt J et al (2013) Comparison of five parathyroid scintigraphic protocols. Int J Mol Imaging 2013:921260Google Scholar
  21. 21.
    Sundin A, Johansson C, Hellman P et al (1996) PET and parathyroid L-[carbon-11] methionine accumulation in hyperparathyroidism. J Nucl Med 37:1766–1770PubMedGoogle Scholar
  22. 22.
    Otto D, Boemer AR, Hofman M et al (2004) Pre-operative localization of hyperfunctioning parathyroid tissue with 11C-methionine PET. Eur J Nucl Med Mol Imaging 31:1405–1412CrossRefPubMedGoogle Scholar
  23. 23.
    Beggs AD, Hain SF (2005) Localization of parathyroid adenomas using 11C-methionine positron emission tomography. Nucl Med Commun 26:133–136CrossRefPubMedGoogle Scholar
  24. 24.
    Tang BN, Moreno-Reyes R, Blocklet D et al (2008) Accurate pre-operative localization of pathological parathyroid glands using 11C-methionine PET/CT. Contrast Media Mol Imaging 3:157–163CrossRefPubMedGoogle Scholar
  25. 25.
    Traub-Weidinger T, Mayerhoefer ME, Koperek O et al (2014) 11C-methionine PET/CT imaging of 99mTC-MIBI-SPECT/CT-negative patients with primary hyperparathyroidism and previous neck surgery. J Clin Endocrinol Metab 99:4199–4205CrossRefPubMedGoogle Scholar
  26. 26.
    Michaud L, Burgess A, Huchet V et al (2014) Is 18F-fluorocholine-positron emission tomography/computerized tomography a new imaging tool for detecting hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism? J Clin Endocrinol Metab 99:4531–4536CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Jukka Schildt
    • 1
  • Virpi Tunninen
    • 2
  • Marko Seppänen
    • 3
  • Camilla Schalin-Jäntti
    • 4
    Email author
  1. 1.Department of Clinical Physiology and Nuclear MedicineUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
  2. 2.Department of Nuclear MedicineSatakunta Central HospitalPoriFinland
  3. 3.Department of Clinical Physiology and Nuclear MedicineTurku PET Centre, University of Turku and Turku University HospitalTurkuFinland
  4. 4.Division of Endocrinology, Department of MedicineAbdominal Center, University of Helsinki and Helsinki University HospitalHelsinkiFinland

Personalised recommendations