Nonlocalizable adenomas by US are most often due to ectopic or far posterior location, MGD, small adenoma size, and concomitant thyroid disease [58,86,91]. The literature in the pediatric population is limited. In a retrospective review of 29 patients, Alagaratnam et al [67] reported that US in 2 neonates resulted in false-negatives; sensitivity improved in older children to 93%. In a separate study of 16 children, sensitivity of US was 60% [7]. Venous Sampling Parathyroid Parathyroid glands tend to drain ipsilaterally and inferiorly relative to their anatomic location. As such, sampling of PTH levels during selective transvenous catheterization of multiple neck and mediastinal veins can be used to Parathyroid Adenoma Variant 2: Adult or child. Primary hyperparathyroidism, recurrent or persistent after parathyroid surgery. Initial imaging. All patients undergoing imaging in the setting of recurrent or persistent PHPT should have biochemically proven disease, as imaging has no role in confirming or excluding the diagnosis [2,10]. As such, assessing the imaging test specificity and negative predictive value is not clinically relevant. Rather, the role of initial imaging in recurrent or persistent PHPT is to accurately identify and localize a parathyroid lesion (or lesions) and identify postoperative changes from previous parathyroid explorations which can impact a subsequent surgery. Accordingly, these criteria focus on imaging test sensitivity and PPV. Multiple imaging modalities may be utilized in combination during the initial imaging evaluation of recurrent or persistent PHPT after prior surgery in an attempt to maximize the accuracy and confidence of parathyroid localization via concordant imaging results [10,15].
Parathyroid Adenoma. Nonlocalizable adenomas by US are most often due to ectopic or far posterior location, MGD, small adenoma size, and concomitant thyroid disease [58,86,91]. The literature in the pediatric population is limited. In a retrospective review of 29 patients, Alagaratnam et al [67] reported that US in 2 neonates resulted in false-negatives; sensitivity improved in older children to 93%. In a separate study of 16 children, sensitivity of US was 60% [7]. Venous Sampling Parathyroid Parathyroid glands tend to drain ipsilaterally and inferiorly relative to their anatomic location. As such, sampling of PTH levels during selective transvenous catheterization of multiple neck and mediastinal veins can be used to Parathyroid Adenoma Variant 2: Adult or child. Primary hyperparathyroidism, recurrent or persistent after parathyroid surgery. Initial imaging. All patients undergoing imaging in the setting of recurrent or persistent PHPT should have biochemically proven disease, as imaging has no role in confirming or excluding the diagnosis [2,10]. As such, assessing the imaging test specificity and negative predictive value is not clinically relevant. Rather, the role of initial imaging in recurrent or persistent PHPT is to accurately identify and localize a parathyroid lesion (or lesions) and identify postoperative changes from previous parathyroid explorations which can impact a subsequent surgery. Accordingly, these criteria focus on imaging test sensitivity and PPV. Multiple imaging modalities may be utilized in combination during the initial imaging evaluation of recurrent or persistent PHPT after prior surgery in an attempt to maximize the accuracy and confidence of parathyroid localization via concordant imaging results [10,15].