• Home
  • Practice Focus
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
    • How I Do It
    • TRIO Best Practices
  • Business of Medicine
    • Health Policy
    • Legal Matters
    • Practice Management
    • Tech Talk
    • AI
  • Literature Reviews
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Career
    • Medical Education
    • Professional Development
    • Resident Focus
  • ENT Perspectives
    • ENT Expressions
    • Everyday Ethics
    • From TRIO
    • The Great Debate
    • Letter From the Editor
    • Rx: Wellness
    • The Voice
    • Viewpoint
  • TRIO Resources
    • Triological Society
    • The Laryngoscope
    • Laryngoscope Investigative Otolaryngology
    • TRIO Combined Sections Meetings
    • COSM
    • Related Otolaryngology Events
  • Search

What Is the Optimal Imaging Modality for Parathyroid Adenoma?

by Curtis Hanba, MD, and Samir S. Khariwala, MD, MS • December 13, 2021

  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.

You Might Also Like

  • Dynamic Optical Contrast Imaging Aids Parathyroid Gland Localization in Ex Vivo Specimens
  • US Effective Initial Localization Study in Patients with Primary Hyperparathyroidism
  • What Is the Best Imaging Modality for Diagnosing a Large Vestibular Aqueduct?
  • What Is the Best Imaging Modality in Evaluating Patients with Unilateral Pulsatile Tinnitus?
Explore This Issue
December 2021

Background

Primary hyperparathyroidism is the most common cause of outpatient hypercalcemia and affects approximately 1% of the population (Ann Surg Oncol. 2011;19:981-989; JAMA Surg. 2016;151:959-968; Ann Surg Oncol. 2012;19:577-583). Unifocal adenomas account for around 85% of disease presentation, with multifocal glandular hyperplasia responsible for a majority of remaining cases (Ann Surg Oncol. 2011;19:981-989; JAMA Surg. 2016;151:959-968; Ann Surg Oncol. 2012;19:577-583). Diagnosis is made biochemically via measurements of total calcium, parathyroid hormone, creatinine, and 25-hydroxyvitamin D levels (JAMA Surg. 2016;151:959-968). Familial hypocalciuric hypercalcemia is assessed preoperatively during a 24-hour urine collection (JAMA Surg. 2016;151:959-968). Surgery is the only definitive treatment for primary hyperparathyroidism and is indicated for patients with symptomatic disease, serum calcium levels >1 mg/dL above normal, cases demonstrating renal involvement, patients with osteoporosis, patients under the age of 50, patients with psychiatric symptoms attributable to hypercalcemia, or patients with coexisting conditions at risk for complications related to hypercalcemia (JAMA Surg. 2016;151:959-968).

 

CLIPAREA | Custom media / Shutterstock

CLIPAREA | Custom media / Shutterstock

Neck exploration remains the gold standard when offering surgical treatment for primary hyperparathyroidism. Minimally invasive single-gland exploration can be offered when preoperative imaging identifies a high likelihood of unifocal disease and intraoperative hormone monitoring reveals an adequate response to extirpation. Common preoperative imaging modalities include ultrasound, scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). The following review aims to detail available imaging modalities with the goal of identifying an optimal preoperative imaging modality when evaluating a patient with primary hyperparathyroidism.

Best Practice

Ultrasound, scintigraphy, 4D CT, and MRI all demonstrate utility when evaluating a patient with primary hyperparathyroidism. Ultrasound offers a real-time anatomic assessment and high-diagnostic sensitivity, making this the evaluation of choice by many parathyroid surgeons. Four-dimensional CT offers increased diagnostic accuracy and cost efficacy when compared to traditional nuclear medicine evaluations. Despite its recent emergence, additional high-quality evidence may result in coalescence around 4D CT as the modality of choice when assessing patients with primary hyperparathyroidism.

Filed Under: Laryngology, Laryngology, TRIO Best Practices Tagged With: parathyroid adenomaIssue: December 2021

You Might Also Like:

  • Dynamic Optical Contrast Imaging Aids Parathyroid Gland Localization in Ex Vivo Specimens
  • US Effective Initial Localization Study in Patients with Primary Hyperparathyroidism
  • What Is the Best Imaging Modality for Diagnosing a Large Vestibular Aqueduct?
  • What Is the Best Imaging Modality in Evaluating Patients with Unilateral Pulsatile Tinnitus?

The Triological SocietyENTtoday is a publication of The Triological Society.

Polls

Would you choose a concierge physician as your PCP?

View Results

Loading ... Loading ...
  • Polls Archive

Top Articles for Residents

  • Applications Open for Resident Members of ENTtoday Edit Board
  • How To Provide Helpful Feedback To Residents
  • Call for Resident Bowl Questions
  • New Standardized Otolaryngology Curriculum Launching July 1 Should Be Valuable Resource For Physicians Around The World
  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Keeping Watch for Skin Cancers on the Head and Neck

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • 22 Symptoms Common to Patients with Superior Canal Dehiscence Syndrome

    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment

    • Rating Laryngopharyngeal Reflux Severity: How Do Two Common Instruments Compare?

    • Is Middle Ear Pressure Affected by Continuous Positive Airway Pressure Use?

    • Otolaryngologists Are Still Debating the Effectiveness of Tongue Tie Treatment

    • Complications for When Physicians Change a Maiden Name

    • Excitement Around Gene Therapy for Hearing Restoration
    • “Small” Acts of Kindness
    • How To: Endoscopic Total Maxillectomy Without Facial Skin Incision
    • Science Communities Must Speak Out When Policies Threaten Health and Safety
    • Observation Most Cost-Effective in Addressing AECRS in Absence of Bacterial Infection

Follow Us

  • Contact Us
  • About Us
  • Advertise
  • The Triological Society
  • The Laryngoscope
  • Laryngoscope Investigative Otolaryngology
  • Privacy Policy
  • Terms of Use
  • Cookies

Wiley

Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 1559-4939