Preoperative Localization for Parathyroid Surgery in Primary and Secondary Hyperparathyroidism

The diagnosis of primary hyperparathyroidism is based on the results of laboratory tests demonstrating elevated plasmatic levels of parathyroid hormone (PTH) and calcium [1]. In patients with suspected primary hyperparathyroidism the role of imaging is usually complementary but it becomes relevant in specific clinical conditions when the correct visualization of a parathyroid mass might confirm the diagnosis or might determine subsequent treatment decisions. This is the case for patients with a not-diagnostic biochemical profile (e.g. elevated PTH with serum calcium level within the normal range) and/or an atypical clinical presentation (e.g. patients without typical signs or symptoms), or that of patients with a mild hyperparathyroidism where the echographic or scintigraphic demonstration of a large adenoma support the surgical decision instead of observation (that might be the option in subjects without a clear parathyroid mass) [2, 3].