This has been illustrated in cases of multiglandular disease, for which surgical options have been limited by inadequate preoperative localization.
Wimmer et al, in a study of patients with multiglandular disease, demonstrated that SPECT/CT was more useful than SPECT alone for preoperative imaging, and they reiterated that increased precision in preoperative imaging is necessary for complex surgical cases.
It is also important to remember the less common multiglandular
involvement with PHPT.
Richards et al at the Mayo Clinic Rochester found that IOPTH monitoring had a sensitivity of 98% and specificity of 91% in primary operations, but the sensitivity dropped to 95% in patients with multiglandular disease (3).
Comparison of quick parathyroid assay for uniglandular and multiglandular parathyroid disease.
Primary hyperparathyroidism is caused by a single gland adenoma in most patients (up to 90%) or multiglandular
In the case of multiglandular disease, it would be expected that the postresection samples would remain increased, indicating the presence of other hyperfunctioning glands, prompting the surgeon to do further exploration to look for additional abnormal glands.
The assay has also been reported to predict severe postoperative hypocalcemia in reoperative patients with multiglandular disease (55).
About 15% of patients with primary hyperparathyroidism have multiglandular
Non-reoperative primary hyperparathyroid patients were further subdivided into patients with uniglandular or multiglandular
Fourteen patients (22%) had multiglandular
disease: 6 with primary hyperplasia, 4 with hyperplasia secondary to renal failure, and 4 with double adenomas.