[MIBI and parathyroid gland function in secondary hyperparathyroidism]
Author(s): Martin F, Sarro F, Verdu J, Gonzalez A, Martinez F
Affiliation(s): Servicio de Nefrologia, Sanatorio Perpetuo Socorro, Alicante.
Publication date & source: 2004, Nefrologia., 24(4):344-50.
The role of the double phase parathyroid scintigraphy with MIBI in the primary hyperparathyroidism has been well studied. The present work analyzes the benefit of this image technique in the diagnosis and therapeutic approach to uremia associated hyperparathyroidism. We studied 18 dialysis patients with clinical and analytical data of hyperparathyroidism. All of them were receiving treatment with i.v. vitamin D. We carried out two scintigraphic studies, the first under basal conditions (without changes in treatment) and the second one, a week later after the stimulation of the parathyroid gland through the cessation of the treatment with vitamin D and phosphorus binders, and the use of a low-calcium dialysate. In the basal study, fourteen patients had a positive uptake test in at least one of the four glands. These patients had significantly higher PTHi levels than those with a negative scintigraphic study. After the stimulation test, we found a statistically significative rise in PHTi (644 vs 979 p < 0.001) and phosphorus levels (5.8 vs 7.3; p < 0.01), a slight fall in calcium levels (p = NS) and a statistically significative increment in the score of scintigraphic captation (5.5 +/- 4.5 vs 6.8 +/- 5; p < 0.05). We found a statistically significative correlation between the PTHi level and the score of scintigraphic uptake, in the basal study (r = 0.6, p < 0.01) and after stimulation (r = 0.6, p < 0.01). The only variable associated with the scintigraphic uptake was PTHi, justifying 31.1% of the variance in the first study and 32.7% in the second. In conclusion, the MIBI scintigraphic is a useful exploration in the uremic patient with hyperparathyroidism, as it predicts the functional state of the parathyroid glands according to uptake intensity. The stimulation test could be useful in planning therapy, but some of its characteristics need to be established, such as the precise time to reach the maximum level of parathyroid stimulation.