Rationale and Objectives
Gaps in primary hyperparathyroidism diagnosis are well-documented. End-organ damage
correlates with disease duration and often occurs before diagnosis. We hypothesize
that opportunistic parathyroid gland assessment on routine CT could decrease existing
diagnosis gaps. Our purpose is to assess for enlarged parathyroid glands on contrast-enhanced
CT acquired prior to biochemical screening and subsequent development of related morbidity.
Materials and Methods
This retrospective study included consecutive patients with primary hyperparathyroidism
undergoing parathyroidectomy with contrast-enhanced CT including the lower neck and
upper chest acquired prior to biochemical screening. One neuroradiologist retrospectively
evaluated all CTs for enlarged (estimated weight greater than 60 mg) parathyroid glands.
Gold standard operative and pathology reports were correlated with CT findings, and
medical records were reviewed for development of primary hyperparathyroidism-related
comorbidities.
Results
The sample comprised 38 patients (30 women, 8 men, median age 60 years) with 70 CTs
of interest. The neuroradiologist identified 32 putative enlarged parathyroid glands
(median estimated weight 307 mg) in 29 (76%) patients on CTs predating biochemical
screening by a median of 30 months. Putative enlarged parathyroid glands on CT corresponded
to pathologically proven parathyroid lesions in 26 (90%) patients. Of 26 patients
with retrospectively identified pathologically proven parathyroid lesions, 12 (46%)
developed at least 1 renal, bone, or neurocognitive comorbidity between CT and subsequent
biochemical screening.
Conclusion
Enlarged parathyroid glands are frequently visible on routine CTs acquired years prior
to primary hyperparathyroidism diagnosis. Biochemical screening based on enlarged
glands could potentially prevent associated morbidity in almost half of such patients.
Key Words
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Article info
Publication history
Published online: June 24, 2022
Accepted:
May 24,
2022
Received in revised form:
May 20,
2022
Received:
April 29,
2022
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
