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Primary hyperparathyroidism localisation — SCE Endocrinology MCQ

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ModerateCalcium/BonePrimary hyperparathyroidism localisationSCE Endocrinology

A 52-year-old woman has recurrent calcium oxalate stones. Calcium is 2.64 mmol/L, PTH 8.2 pmol/L and vitamin D is 38 nmol/L. Neck ultrasound is negative. What is the most appropriate next investigation for localisation after biochemical diagnosis?

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Correct answer: D — Sestamibi scan or 4D-CT in a specialist pathway

After biochemical primary hyperparathyroidism is established, localisation may use ultrasound, sestamibi or 4D-CT to plan surgery. Negative ultrasound does not exclude a parathyroid adenoma. Localisation tests should not be used to make the biochemical diagnosis.

Reference: NICE NG132; Society for Endocrinology Calcium Guidance