Negative Scintigraphy in Primary Hyperparathyroidism
Keywords:
primary hyperparathyroidism; parathyroid scintigraphy; parathyroid adenoma.Abstract
Introduction: Primary hyperparathyroidism is characterized by excessive secretion of parathyroid hormone, manifesting as hypercalcemia, hypophosphatemia, and hyperphosphaturia. It presents in various forms, the most common of which is the asymptomatic form. Parathyroid scintigraphy is a diagnostic study with the highest sensitivity and specificity for establishing the etiology of the disease.
Objective: To describe the clinical and biological factors that lead to a negative scintigraphy result in patients with primary hyperparathyroidism.
Methods: An exhaustive search for scientific articles was conducted across databases such as PubMed, Scopus, Medigraphic, and Google Scholar. Twenty-nine articles met the selection criteria, and keywords such as "hyperparathyroidism," "adenoma," and "scintigraphy" were used for the search.
Conclusions: Parathyroid scintigraphy constitutes the most specific study for the etiological diagnosis of this disease; however, it must be noted that a small percentage of these patients do not exhibit tracer uptake. This lack of uptake is associated with specific clinical and biological factors; therefore, a negative result does not rule out the possibility of primary hyperparathyroidism.
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1. Rappoport Wurgaft DA, Caballero Quintana MG, Cortés Bórquez NJ, Cabané Toledo PE, Gac Espinoza PJ, Rodríguez Moreno FJ. Hiperparatiroidismo primario. Rev Cir (Mex). 2021 [acceso 20/02/2025];73(2). Disponible en: https://www.revistacirugia.cl/index.php/revistacirugia/article/view/910
2. Ruiz LFGF, Vázquez NGC, Hernández VS, Pérez SM, Nieto GS, Ayala OC, et al. Hiperparatiroidismo primario; un caso para el internista. Med Interna México. 2023 [acceso 20/02/2025];39(6):940-7. Disponible en: https://www.medigraphic.com/pdfs/medintmex/mim-2023/mim236o.pdf
3. Expert Panel on Neurological Imaging, Zander D, Bunch PM, Policeni B, Juliano AF, Carneiro-Pla D, et al. ACR Appropriateness Criteria® Parathyroid Adenoma. J Am Coll Radiol. 2021 [acceso 20/02/2025];18(11S):S406-22. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34794597/
4. Morris MA, Saboury B, Ahlman M, Malayeri AA, Jones EC, Chen CC, et al. Parathyroid imaging: past, present, and future. Front Endocrinol. 2022 [acceso 20/02/2025];12:760419. Disponible en: https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2021.760419/full
5. Del Rio P, Tosi G, Loderer T, Bonati E, Cozzani F, Ruffini L. Preoperatory imaging evaluation in primary hyperparathyroidism and associated thyroid disease. Ann Ital Chir. 2021 [acceso 20/02/2025];92:471-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34795109/
6. Torres MM. Actualización en el hiperparatiroidismo primario. XXVIII Curso Postgrado SEEP Actual en Endocrinol Pediátrica. 2022 [acceso 20/02/2025];(47). Disponible en: https://www.endocrinologiapediatrica.org/modules/editorial/files/cursoseep_2022-v5.pdf
7. Jason DS, Balentine CJ. Intraoperative Decision Making in Parathyroid Surgery. Surg Clin North Am. 2019;99(4):681-91. DOI: https://sci-hub.ru/https://doi.org/10.1016/j.suc.2019.04.008
8. Baj J, Sitarz R, Łokaj M, Forma A, Czeczelewski M, Maani A, et al. Preoperative and Intraoperative Methods of Parathyroid Gland Localization and the Diagnosis of Parathyroid Adenomas. Molecules. MDPI AG. 2020 [acceso 20/02/2025];25(7):1724. Disponible en: https://www.researchgate.net/publication/340528874_Preoperative_and_Intraoperative_Methods_of_Parathyroid_Gland_Localization_and_the_Diagnosis_of_Parathyroid_Adenomas
9. Silva BC, Cusano NE, Bilezikian JP. Primary hyperparathyroidism. Best Pract Res Clin Endocrinol Metab. 2018;32(5):593-607. DOI: https://sci-hub.ru/https://doi.org/10.1016/j.beem.2018.09.004
10. Kowalski G, Buła G, Żądło D, Gawrychowska A, Gawrychowski J. Primary hyperparathyroidism. Endokrynol Pol. 2020 [acceso 20/02/2025];71(3):260-70. Disponible en: https://journals.viamedica.pl/endokrynologia_polska/article/view/EP.a2020.0028/51267
11. Walker M, Bilezikian J. Feingold KR, Adler RA, Ahmed F, Anawalt B, et al. In: Primary Hyperparathyroidism. editors Endotext South Dartmouth (MA). 2021 [acceso 20/02/2025]. Disponible en: https://pubmed.ncbi.nlm.nih.gov/25905161/
12. Bilezikian JP, Khan AA, Silverberg SJ, Marcocci C, MinisolaS, Perrier N, et al. Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the fifth international workshop. J Bone Mineral Res. 2022 [acceso 20/02/2025];37(11):2293-314. Disponible en: https://academic.oup.com/jbmr/article/37/11/2293/7512381
13. Muñoz Torres M, García Martín, A. Hiperparatiroidismo primario. Med Clin (Barc). 2018;150:226-32. DOI: https://sci-hub.ru/https://doi.org/10.1016/j.medcle.2018.01.009
14. Dandurand K, Ali D, Khan A. Primary Hyperparathyroidism: A Narrative Review of Diagnosis and Medical Management. Journal of Clinical Medicine. 2021 [acceso 20/02/2025];10(8):1604. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8068862/
15. Islam A. Advances in the diagnosis and the management of primary hyperparathyroidism. Ther Adv in Chronic Dis. 2021;12. DOI: https://doi.org/10.1177/20406223211015965
16. Zhu C, Sturgeon C, Yeh M. Diagnosis and Management of Primary Hyperparathyroidism. JAMA. 2020 [acceso 20/02/2025];323(12):1186-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32031566/
17. Schini M, Jacques R, Oakes E, Peel N, Walsh J, Eastell R. Normocalcemic Hyperparathyroidism: Study of its Prevalence and Natural History. J Clin Endocrinol Metab. 2020 [acceso 20/02/2025];105(4):e1171-86. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32072184/
18. Jawaid I, Rajesh S. Hyperparathyroidism (primary) NICE guideline: diagnosis, assessment, and initial management. British Journal of General Practice. 2020 [acceso 20/02/2025];70(696):362-63. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32586826/
19. Boccalatte L, Gómez N, Olivera S, Yanzon A, Abuawad C, Smith D, et al. Ectopic hyperparathyroidism. Detection of mediastinal localization. Medicina. 2020 [acceso 20/02/2025];80(1):39-47. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32044740/
20. Asseeva P, Paladino NC, Guerin C, Castinetti F, Vaillant-Lombard J, Abdullah AE, et al. Valor de123I/99m Gammagrafía paratiroidea con Tc-sestamibi con SPECT/TC de sustracción en hiperparatiroidismo primario para dirigir la paratiroidectomía mínimamente invasiva. Soy J Surg. 2019 [acceso 20/02/2025];217:108-13. Disponible en: https://pmc-ncbi-nlm-nih-gov.translate.goog/articles/PMC4333274/?_x_tr_sl=en&_x_tr_tl=es&_x_tr_hl=es&_x_tr_pto=tc
21. Acín D, Pereira F, Medina M, Viana S. Factores que condicionan la sensibilidad de la ecografía y la gammagrafía en la localización del adenoma paratiroideo. Cir Esp. 2020 [acceso 20/02/2025];98:18-25. Disponible en: https://sci-hub.ru/https://doi.org/10.1016/j.ciresp.2019.09.002
22. García-Talavera San Miguel P, Gómez-Caminero López F, Villanueva Curto JG, Tamayo Alonso MP, Martín Gómez ME. Update of the role of Nuclear Medicine techniques in the pre-surgical localization of primary hyperparathyroidism. Rev Esp Med Nucl Imagen Mol (Engl Ed). 2019 [acceso 20/02/2025];38(2):123-35. Disponible en: https://sci-hub.box/downloads/2019-11-18/82/10.1016@j.remnie.2019.01.006.pdf
23. Park HS, Hong N, Jeong JJ, Yun M, Rhee Y. Update on Preoperative Parathyroid Localization in Primary Hyperparathyroidism. Endocrinol Metab (Seoul). 2022 [acceso 19/03/2025];37(5):744-55. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/pmid/36327985/
24. Neumann DR, Esselstyn CB, Madera A. Detección de paratiroides en hiperparatiroidismo secundario con tomografía computarizada por emisión de fotón único con sustracción de 123I/99mTc-sestamibi. J Clin Endocrinol Metab. 1998;83(11):3867-71. DOI: https://sci-hub.ru/https://doi.org/10.1210/jcem.83.11.5241
25. Mi J, Fang Y, Xian J, Wang G, Guo Y, Hong H, et al. Comparative Effectiveness of MRI, 4D-CT and Ultrasonography in Patients with Secondary Hyperparathyroidism. Ther Clin Risk Manag. 2023 [acceso 19/03/2025];19:369-81. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10163888/pdf/tcrm-19-369.pdf
26. Blocklet D, Martin P, Schoutens A. Localización prequirúrgica de glándulas paratiroides anormales mediante una única inyección de tecnecio-99m metoxiisobutilisonitrilo: comparación de diferentes técnicas, incluido el análisis factorial de estructuras dinámicas. Revista Europea de Medicina Nuclear. 1997 [acceso 19/03/2025];24(1):46-51. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC6381465/pdf/10.1177_0300060518813742.pdf
27. Tay D, Das JP, Yeh R. Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review. Biomedicines. 2021 [acceso 19/03/2025];9(4):390. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8067482/pdf/biomedicines-09-00390.pdf
28. Buakhao Ch, Vachatimanont S. Comparing early and delayed [99mTc] Tc-MIBI SPECT/CT parathyroid scans: agreement, confidence levels, and clinical predictive factors. Egypt J Radiol Nucl Med 2024;55:134. DOI: https://ejrnm.springeropen.com/counter/pdf/10.1186/s43055-024-01311-1.pdf
29. Kunstman JW, Udelsman R. Superiority of minimally invasive parathyroidectomy. Adv Surg. 2012 [acceso 21/03/2025];46:171-89. Disponible en: https://pubmed.ncbi.nlm.nih.gov/22873039/
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Copyright (c) 2026 Adalberto Luis Infante Amorós, Melissa Toledo Licourt, Sergio Enrique Zayas Puig, Ana del Carmen Argüelles Zayas, Leydis Gómez Díaz Gómez Díaz, Eduardo René Valdés Bencosme
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