Parathyroid venous sampling and ultrasonography in primary hyperparathyroidism due to multigland disease

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Abstract
Results of pre-operative venous sampling and ultrasonography in 20 patients with primary hyperparathyroidism, who were shown histologically to have multigland disease, were reviewed. Ultrasonography (15 patients) demonstrated abnormal parathyroid tissue in 46% (7 patients) but correctly predicted only 33% of the involvement or non-involvement of individual glands. The main deficiency was the high number of false negatives. Parathyroid venous sampling (19 patients) showed elevated levels of parathyroid hormone in 18 (94.7%) but overall the sites of normal and abnormal glands were predicted in 56 of 76 sites (73.6%). The investigation was misleading in 1 patient (5.2%), in that no abnormal glands were predicted. The sampling maps of the above 19 patients were randomly mixed with those of 100 consecutive patients, whose disease was due to a single adenoma. All but 1 of the multigland disease cases were identified correctly but 6 of the single adenoma patients were predicted as having 2 glands involved, and were therefore thought to be multigland. The usefulness of, and difficulties in, diagnosing multigland disease in primary hyperparathyroidism are discussed.