Incidentalomas during imaging for primary hyperparathyroidism—incidence and clinical outcomes

Abstract

BackgroundImaging for pre-operative localisation of parathyroid glands in primary hyperparathyroidism is now routine. This has led to the detection of incidental lesions (incidentalomas) in other organs, the nature of which is not well characterised.The aim of this study was to determine the incidence, characteristics and outcomes in patients who had incidental findings on parathyroid imaging.MethodsRecords of patients who underwent imaging for primary hyperparathyroidism over 2 years were reviewed to identify incidental lesions detected on parathyroid imaging. Patients with persistent or renal hyperparathyroidism were excluded. Details on the management of detected incidentalomas were obtained from patient records.ResultsIncidentalomas were identified in 17 of 170 patients (10 %) undergoing parathyroid imaging. Incidentalomas included thyroid (n = 11), breast (n = 3), lateral compartment of the neck (n = 1), lung (n = 1) and clavicle (n = 1). However, no disease of clinical significance needing treatment was detected on further investigation.ConclusionsAlthough a significant proportion of patients undergoing parathyroid imaging had incidental lesions detected, these seem to be of little clinical significance. The morbidity and cost of further interventions on these incidentalomas need to be weighed against the benefits of routine imaging in improving outcomes of first-time surgery in patients with primary hyperparathyroidism.

The Incidental Thyroid Lesion in Parathyroid Disease Management

“…16 These results are comparable to our data. Another study revealed that approximately only 2% of all patients with primary hyperparathyroidism undergoing ultrasound testing subsequently had thyroid cancer, 17 which is very low compared with our findings and other published data. Ogawa et al 18 did show the high prevalence of thyroid disorders in patients with hyperparathyroidism, and they found malignant thyroid tumors in 10.6% of their study population.…”