Hyperparathyroidism (HPT) is an endocrine disorder characterised by an increase in the secretion of parathyroid hormone (PTH), with a resulting increase in calcium plasma levels, which can cause renal lithiasis, fractures, and osteoporosis, the most frequent symptoms of the disease. Neck ultrasonography and sestamibi scan are the first-line examinations to locate the hyper functional glands.

Positron emission tomography (PET) performed with computed tomography with 18 F-fluorocholine (18fluorocholine PET/CT) has emerged in the past four years as a potential diagnostic method for HPT. Sixteen papers published from 2014 to 2018 comprising 619 patients were selected for this systematic review. Sensitivity ranged between 80% and 100%. On the other hand, specificity varied between 95% and 100%.

The diagnostic accuracy rate of 18F-fluorocholine PET/CT is high for the detection of parathyroid adenomas, and allows the performance of a minimally invasive surgery with less risk of postoperative hypocalcaemia and damage to the recurrent laryngeal nerve, and a decrease in surgical procedure times and healthcare costs, thus resulting in a quick recovery and early hospital discharge. In addition, it has advantages over sestamibi in terms of image quality and short performance time. Studies are required that comprehensively assess costs for the healthcare system.

Usefulness of 18F-Fluorocholine Positron Emission Tomography-Computed Tomography in Locating Lesions in Hyperparathyroidism: A Systematic Review.
Boccalatte LA, Higuera F, Gómez NL, et al.
2019 Epub ahead of print.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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