Primary hyperparathyroidism is a condition characterized by overproduction of PTH, which invariably leads to an elevation in blood calcium levels by releasing calcium from bone and increasing retention of calcium by the kidneys and intestines. The diagnosis is often made when routine blood testing demonstrates an elevated blood calcium level. In other cases, the patient may present with symptoms which leads the astute clinician to evaluate the patient for a parathyroid disorder. Twenty-four hour urine collections for calcium and bone density studies may also play a role in the diagnosis.
Common symptoms of primary hyperparathyroidism systems include:
- Loss of appetite
- Frequent urination
- Muscle weakness
- Joint pain
- Nausea and vomiting
- Trouble with concentration and/or memory loss
Medical conditions that may be caused by overactive parathyroid glands include:
- Kidney stones
- Osteopenia and osteoporosis
- Unintentional weight loss
- Pancreatitis or ulcers
- Blood in the urine
- Glucose intolerance and diabetes
Rationale for Parathyroid Localizing Studies
Parathyroid localization for targeted or minimally invasive parathyroid surgery is the preferred approach at the Mount Sinai Parathyroid Program. To plan for a minimally invasive approach, preoperative localizing studies are obtained in all patients so that the surgical team can have as much anatomical information about abnormal parathyroid gland location as possible prior to surgery. You will undergo an office-based parathyroid ultrasound by your surgeon during your consultation. Other localizing studies that are available at the Mount Sinai Parathyroid Program include:
- Thin-cut parathyroid CT scanning (with dedicated parathyroid radiologist)
- Sestamibi scanning with SPECT
- Selective venous sampling for PTH
All of these studies provide complementary information and there is no one preferred study. That being said, in our experience parathyroid CT scanning has emerged as the most accurate localizing study. CT scanning typically takes 5 minutes to perform, unlike sestamibi scanning which can take up to 5 hours to complete.
Once the localizing studies have been completed, your surgeon will have a “road map” in place showing how best to conduct your operation in a minimally invasive manner. Our philosophy is to perform the least amount of surgery possible to cure you of your condition.
Intraoperative parathyroid hormone testing (PTH) monitoring is utilized in every parathyroid operation at the Mount Sinai Parathyroid Program. Intraoperative PTH testing is an intraoperative point of care test that allows your surgeon to assess the completeness of surgery prior to the patient leaving the operating room. With a greater than 99% accuracy, an appropriate reduction in your PTH levels during surgery confirms that you are cured of your parathyroid disease before you leave the operating room.
Your surgeon will use a combination of preoperative localizing studies, intraoperative findings and intraoperative PTH levels to determine the extent of surgery. Since 90 percent or more of cases of primary hyperparathyroidism are caused by a solitary parathyroid adenoma, the extent of surgery is usually minimal. The surgeons at the Mount Sinai Parathyroid Program have considerable expertise in performing parathyroid surgery under local anesthesia using the latest minimally invasive techniques, leading to less pain and a quick recovery.