The following is a summary of “Comparative utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism,” published in the FEBRUARY 2023 issue of Surgery by Montgomery, et al.

It has been proven that parathyroidectomy is beneficial for people with normocalcemic primary hyperparathyroidism (PHPT). However, the efficacy of preoperative imaging in normocalcemic PHPT compared to hypercalcemic PHPT needs to be better defined, but PHPT can be localized preoperatively using a variety of imaging modalities.

A retrospective review was done on all PHPT patients who underwent parathyroidectomy between 2001 and 2019. Groups of patients with normocalcemia and those with hypercalcemia were stratified. In addition, data on patients and results were examined.

The database’s 2,218 patients were all included. 1,785 patients had hypercalcemic PHPT (80.5%), while 433 patients had normocalcemic PHPT (19.5%). Equivalent cure rates (100% vs. 99%) were observed across patients with preoperative imaging and those without it in normocalcemic individuals. The only variation in postoperative consequences found was a small increase in transitory hypocalcemia in individuals without imaging.

The study found that patients with normocalcemic PHPT who underwent parathyroidectomy had comparable cure and complication rates regardless of whether they had preoperative imaging. In contrast, hypercalcemic PHPT patients benefited from preoperative imaging to locate the affected parathyroid gland. The authors suggest that routine localization studies for normocalcemic PHPT may be unnecessary, and experienced surgeons may rely on intraoperative adjuncts for exploration instead.

Reference: americanjournalofsurgery.com/article/S0002-9610(22)00591-8/fulltext