Clinical Characterization of Post-parathyroidectomy Patients with Primary Hyperparathyroidism and the Concordance of Preoperative Localization Imaging with Histopathology at a Tertiary Hospital in Manila, Philippines




primary hyperparathyroidism,, parathyroidectomy, parathyroid localization


*Visual Abstracts prepared by Dr. Roy Raoul Felipe

Background. Philippine studies on primary hyperparathyroidism (PHPT) and preoperative localization are scarce, making improvements on detection and recognition particularly difficult.

Objective. Describe the clinical profile of post-parathyroidectomy PHPT patients at The Medical City (TMC) and
assess localization rates and concordance of neck ultrasound (UTZ) and 99mTc-sestamibi scan (MIBI) with surgical histopathologic findings.

Methodology. Retrospective chart review of PHPT Filipino patients who underwent parathyroidectomy at The Medical City from January 2004 to August 2018. Clinical profile and presentations were described and compared with international data. Imaging results were compared with surgical histopathology findings and the level of agreement was determined.

Results. Thirty-five patients were analyzed with female predominance (63%) and an average age of 53 years. Our population had more overt manifestations including skeletal abnormalities (51%), renal calculi (49%) and musculoskeletal symptoms (43%) prior to surgery compared to western countries, where symptoms were noted in less than 20%. MIBI had higher rates of detection than UTZ (80% versus 58%) but had similar localization rates (96.4% versus 94%). When performed together, given a positive result from either test, a much higher yield (93.8%) was observed. The level of agreement between MIBI and surgery was 72.5% (κ=0.54) while UTZ and surgery was 54.1% (κ=0.38).

Conclusion. Our Filipino subjects had predominantly overt symptomatic hyperparathyroidism upon diagnosis prior to surgery as opposed to more asymptomatic surgical patients in western countries. Combining UTZ and MIBI is a more successful preoperative localization approach in our setting than performing either imaging alone, especially in patients with nodular goiter.


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Author Biographies

Danica Chan Francisco, The Medical City, Pasig City

Section of Endocrinology, Diabetes and Metabolism, Department of Medicine

Elizabeth Paz-Pacheco, The Medical City, Pasig City

Section of Endocrinology, Diabetes and Metabolism, Department of Medicine


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How to Cite

Francisco, D. C., Paz-Pacheco, E. ., & Wagan, P. A. (2020). Clinical Characterization of Post-parathyroidectomy Patients with Primary Hyperparathyroidism and the Concordance of Preoperative Localization Imaging with Histopathology at a Tertiary Hospital in Manila, Philippines. Journal of the ASEAN Federation of Endocrine Societies, 35(1), 77–84.



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