Factores asociados con la ausencia de captación en la gammagrafía con 99mTc-MIBI en pacientes con hiperparatiroidismo primario

Abstract

ObjectiveThe objective was to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning in patients with primary hyperparathyroidism (PHPT). Material and methodsA retrospective observational study was designed in 195 patients (mean age: 59.2±13.0years; 77% woman) with PHPT (calcium: 11.3±1.1mg/dl and PTH: 218±295pg/ml) studied in endocrinology setting between 2013 and 2020. An univariate and multivariate analysis was made to evaluate the clinical and biological factors associated with negative 99mTc-MIBI scanning. Results50 patients (26%) with negative 99mTc-MIBI scanning had lower PTH levels (146±98 vs. 244±334; p<0.001), adenomas with smaller sonographic dimensions (maximum diameter: 1.2±0.4 vs. 1.7±0.9cm; p=0.001 and volume: 0.36±0.43 vs. 1.7±4.1cm3; p<0.001), localized more frequently in upper parathyroid glands (37% vs. 14%; p=0.005) and associated more frequently to thyroid nodules (72% vs. 57%; p=0.045) than patients with positive scanning. 116 patients were operated and parathyroid adenomas were smaller (maximum diameter: 1.3±0.5 vs. 1.9±1.1cm; p=0.008 and volume: 0.30±0.20 vs. 1.2±1.1cm3; p<0.001), less heavy (567±282 vs. 1470±1374mg; p=0.030) and were localized more frequently in upper situation (65% vs. 16%; p<0.001) than patients with positive scanning. In the multivariate analysis an independent association between negative 99mTc-MIBI scanning and size of removed adenoma ≤1cm (OR: 5.77; 95% CI: 1.46-22.71) and upper adenoma localization were observed (OR: 8.05; 95% IC: 2.22-29.16). ConclusionsOne in four patients studied for PHPT had a negative 99mTc-MIBI scanning and were independent associated with size of adenoma ≤1cm and upper adenoma localization.