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Primary hyperparathyroidism (PHPT) is the result of a hyperfunctioning single gland in 85% of cases; the minority of cases are attributed to parathyroid hyperplasia or multigland disease. The definitive management of PHPT is parathyroidectomy, which is accomplished via bilateral neck exploration (BNE), unilateral neck exploration (UNE) or focused, minimally invasive parathyroidectomy (MIP), with equivalent operative success rates of >95%. Preoperative localization studies, which have traditionally included ultrasound and technetium Tc 99m sestamibi scanning, are utilized to facilitate preoperative identification of abnormal parathyroid glands and the ability to perform MIP. With the advent of MIP, BNE, in which all four parathyroid glands are identified prior to resection of the abnormal gland(s), is reserved for patients with nonlocalized PHPT or suspected of multigland disease. To better identify potentially abnormal glands preoperatively, “4D CT” was developed as an alternative localization strategy as compared to proceeding with BNE in patients with otherwise nonlocalized disease. This chapter reviews the most recent guidelines surrounding nonlocalized PHPT and literature surrounding utilization of BNE and 4D CT and associated outcomes for comparison.

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Four Gland Exploration Versus Four Dimensional Computed Tomography in Patients with Nonlocalized Primary Hyperparathyroidism

  • 章节

  • 发表日期：

    2025年

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  • Alexa B. Lisevick-Kumar,
  • Tracy S. Wang

摘要

Primary hyperparathyroidism (PHPT) is the result of a hyperfunctioning single gland in 85% of cases; the minority of cases are attributed to parathyroid hyperplasia or multigland disease. The definitive management of PHPT is parathyroidectomy, which is accomplished via bilateral neck exploration (BNE), unilateral neck exploration (UNE) or focused, minimally invasive parathyroidectomy (MIP), with equivalent operative success rates of >95%. Preoperative localization studies, which have traditionally included ultrasound and technetium Tc 99m sestamibi scanning, are utilized to facilitate preoperative identification of abnormal parathyroid glands and the ability to perform MIP. With the advent of MIP, BNE, in which all four parathyroid glands are identified prior to resection of the abnormal gland(s), is reserved for patients with nonlocalized PHPT or suspected of multigland disease. To better identify potentially abnormal glands preoperatively, “4D CT” was developed as an alternative localization strategy as compared to proceeding with BNE in patients with otherwise nonlocalized disease. This chapter reviews the most recent guidelines surrounding nonlocalized PHPT and literature surrounding utilization of BNE and 4D CT and associated outcomes for comparison.