Utilidad de la gammagrafía con Sestamibi y la determinación de hormona paratiroidea intacta como técnicas de localización de tejido paratiroideo hiperfuncionante

Objective. To assess the utility of 99mTc-sestamibi and the determination of intact parathyroid hormone (iPTH) as techniques for locating abnormal glands in patients with primary hyperparathyroidism (HPT) and to test the utility of the determination of iPTH to confirm the resection of all hyperfunctioning tissue.
Patients and methods. Eleven patients with a postoperative diagnosis of primary HPT due to parathyroid adenoma were studied. All the patients had undergone preoperative 99mTc-sestamibi scintigraphy and the determination of iPTH in both jugular veins for the purpose of locating the abnormal side. Preoperative and postoperative (15 minutes after resection) iPTH levels were also measured in the attempt to confirm the complete resection of hyperfunctioning tissue.
Results. 99mTc-sestamibi scintigraphy showed a sensitivity of 91.6% and a specificity of 100%. Venous iPTH determination correctly identified the diseased side in 45.4% of cases, and the resection of all hyperfunctioning tissue was confirmed in 10 of the 11 patients (90.9%).
Conclusions.. Preoperative 99mTc-sestamibi scintigraphy is a reliable test for the localization of abnormal parathyroid glands, in contrast to the intraoperative determination of iPTH. The comparison of the preoperative iPTH level with that obtained 15 minutes postresection is a good indicator of the effectiveness of the procedure.