Imaging of the parathyroid glands in primary hyperparathyroidism

Primary hyperparathyroidism is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral cervical exploration under general anaesthesia has been the standard for the definitive treatment; however, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before operation (both in the classical scenario and in the minimally invasive procedure); they are not satisfied by having been referred a patients with just a biochemical diagnosis of PHPT. Imaging studies mustn't be utilized to make the diagnosis of primary hyperparathyroidism; they should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localisation. Therefore, surgical expertise is more important that the search for abnormal parathyroid glands.