The Essentials of Parathyroid Hormone Venous Sampling

Abstract

Hyperparathyroidism is an excess of parathyroid hormone in the blood due to over-activity of one or more parathyroid gland. Localization of abnormal glands with noninvasive imaging modalities, such as technetium sestamibi scan and cross-sectional imaging, has a high success rate. Parathyroid venous sampling is performed for patients with persistent or recurrent disease after previous parathyroid surgery, when repeat noninvasive imaging studies are negative or discordant. The success of invasive localization studies and results interpretation is dependent on the interventional radiologist's understanding of the normal and ectopic anatomic locations of parathyroid glands, as well as their blood supply and venous drainage. Anatomic and technical considerations for selective parathyroid venous sampling are reviewed.

A young girl with “bones, abdominal groans, thrones and psychic moans”

“…Parathyroid venous sampling is an invasive method to determine the location of the hyper-functioning parathyroid tissue when the noninvasive imaging techniques are rendered inconclusive such as incompatible functional and anatomical imaging or inability to accurately localize the lesion (4). Though high success rates can be obtained if precisely performed, several technical difficulties and pitfalls may act as confounders (5). The index patient had multi-gland disease as demonstrated by the venous sampling and underwent four gland exploration with three and half gland removal.…”

Role of Venous Sampling in the Diagnosis of Endocrine Disorders

“…As the thyroid plexus does not contain valves, a retrograde venogram through any thyroid vein may be taken to identify the anatomy prior to individual cannulation ( Figure 7 ). Various catheter shapes along with microcatheters may be required for selective catheterization in PVS [ 54 ]. About 2–3 mL samples are taken from each site and sent to the laboratory.…”

Parathyroid Adenoma of the Piriform Sinus: Case Series, Embryologic Basis, and Review of the Literature

“…Nonetheless, pre-operative imaging may not successfully identify an abnormally secreting gland and have false-positive rates ranging from 5 to 25%. Approximately 17% of patients with a surgically identified and biochemically confirmed oversecreting gland have negative pre-operative imaging (14,15). While no definitive algorithm for imaging ectopic parathyroid adenomas exists, the authors of this study recommend the concordance of two pre-operative localization studies prior to surgery, with particular emphasis on 99m technetium sestamibi scans, SPECT/CT, and four-dimensional CT, which have high sensitivity and positive predictive value (15).…”

“…While no definitive algorithm for imaging ectopic parathyroid adenomas exists, the authors of this study recommend the concordance of two pre-operative localization studies prior to surgery, with particular emphasis on 99m technetium sestamibi scans, SPECT/CT, and four-dimensional CT, which have high sensitivity and positive predictive value (15). Parathyroid venous sampling (PVS) is a helpful technique in cases where noninvasive imaging cannot localize the source of ectopic PTH production or in patients with small overactive parathyroid glands or with multigland disease (15). Nonetheless, the decision to utilize PVS is contingent on surgeon experience, institution availability, and patient willingness to undergo an invasive procedure.…”

“…Approximately 17% of patients with a surgically identified and biochemically confirmed oversecreting gland have negative pre-operative imaging (14,15). While no definitive algorithm for imaging ectopic parathyroid adenomas exists, the authors of this study recommend the concordance of two pre-operative localization studies prior to surgery, with particular emphasis on 99m technetium sestamibi scans, SPECT/CT, and four-dimensional CT, which have high sensitivity and positive predictive value (15). Parathyroid venous sampling (PVS) is a helpful technique in cases where noninvasive imaging cannot localize the source of ectopic PTH production or in patients with small overactive parathyroid glands or with multigland disease (15).…”