Comparison of parathyroid scintigraphy findings in pediatric and adult patients with secondary hyperparathyroidism

Abstract

Objectives Secondary hyperparathyroidism (sHPT) is a compensatory complication of chronic kidney disease. The aim of this study was to compare PS findings in pediatric and adult patients with sHPT. Methods This study included 50 pediatric and 50 adult patients with sHPT. Parathyroid scintigraphy was performed with Tc-99m sestamibi. After radiopharmaceutical injection, early-phase (15 min) and late-phase (60–90 min) images were acquired. Planar images were interpreted visually for the presence / number of active foci compatible with a parathyroid lesion, the presence and degree of uptake in skeletal structures, and the degree of thyroid sestamibi uptake. Parathyroid surgery was performed in 21 pediatric and 28 adult patients. Results Serum PTH and ALP values were significantly higher in pediatric than in adult patients (P < 0.05 for each). In operated patients, on a lesion-based analysis, the sensitivity of PS in pediatric and adult patients were 40% and 71%, respectively. A nonlocalizing scan was observed in 24% of pediatric patients. Pediatric patients had a higher incidence of reduced thyroid sestamibi uptake (42% versus 2%). Skeletal sestamibi uptake was detected in 40% of pediatric and 30% of adult patients and the degree of uptake was higher in pediatric patients. Conclusions The results revealed more significant changes in the biochemical profile of pediatric compared with adult patients with sHPT. The sensitivity of PS was lower, and the likelihood of a nonlocalizing scan was higher in pediatric patients. The results may also suggest more severe skeletal findings in pediatric patients. Reduced thyroid sestamibi uptake in children needs further evaluation.

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

“…uptake at the thyroid level (42% versus 2%) [29]. The pre-surgery detection rate is generally higher in PHP than in the secondary type [30].…”

“…A multi-glandular disease (generally representing 20% of the adult cases with PHP, particularly those with a strong genetic background) associates with a higher rate of identification failure regardless of the presurgery functional imaging modalities (particularly when ectopic pathological glands are also involved) [28]. 99m-Tc sestamibi plan scintigraphy has been used not only in PHP, but also in secondary (chronic kidney disease-associated) hyperparathyroidism, with the sensitivity for paediatric cases being lower than seen in the adult population (for example, 40% versus 70%) with an increased rate of reduced radiotracer uptake at the thyroid level (42% versus 2%) [29]. The pre-surgery detection rate is generally higher in PHP than in the secondary type [30].…”