WTP2.4 Can we predict parathyroid adenoma size preoperatively with biochemical markers?

Abstract

Abstract Aim In primary hyperparathyroidism, parathyroidectomy remains the mainstay of treatment. However, localising abnormal parathyroid glands can often prove challenging, and re-operations may be necessary. We aim to evaluate any correlation that might exist between parathyroid hormone (PTH) levels, preoperative peak corrected calcium levels and cinacalcet use with adenoma size. Methods We retrospectively reviewed consecutive parathyroidectomies performed for primary hyperparathyroidism by two experienced upper gastrointestinal surgeons (VS and PT) in a teaching hospital between April 2013 and December 2022. Hospital database was accessed to obtain data for biochemical markers, operation notes and histopathology reports. Spearman correlation coefficient was computed to evaluate linear relationship between PTH, peak calcium levels and adenoma size. Mann-Whitney-U test was used to compare cinacalcet use and adenoma sizes. P-value<0.05 was statistically significant. Results 170 parathyroidectomies for primary hyperparathyroidism were performed during the study period. Patient cohort was predominantly female (n=131, 77.1%). Mean age of study population was 58±12 years. There were positive correlations between adenoma size and preoperative peak corrected calcium levels (R=0.25, p=0.001) and PTH levels (R=0.4, p<0.001) respectively. In patients who took cinacalcet preoperatively (n=46, 27.1%), there was an association with larger adenoma size (18±8mm vs 22±12mm, p=0.009). Conclusion Higher preoperative PTH levels and peak corrected calcium levels along with cinacalcet use may be associated with larger adenoma sizes. Further studies are required to validate these findings.