Preoperative Location Of Parathyroid Adenomas In Primary Hyperparathyroidism: The Role of Cervical Doppler Ultrasound

Sara Amaral; Teresa Rego; Ana Palha; Nuno Carrilho; José Mário Coutinho; Paula Tavares; José Silva-Nunes

doi:10.20344/amp.18735

Autores

Sara Amaral Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon. https://orcid.org/0000-0002-2911-9270
Teresa Rego Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon.
Ana Palha Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon.
Nuno Carrilho Radiology Department. Centro Hospitalar Universitário Lisboa Central. Lisbon
José Mário Coutinho Endocrine Surgery Department. Centro Hospitalar Universitário Lisboa Central. Lisbon.
Paula Tavares Endocrine Surgery Department. Centro Hospitalar Universitário Lisboa Central. Lisbon.
José Silva-Nunes Endocrinology, Diabetes and Metabolism Department. Centro Hospitalar Universitário Lisboa Central. Lisbon. NOVA Medical School. Faculdade de Ciências Medicas. Universidade NOVA de Lisboa. Lisbon. Health and Technology Research Center. Escola Superior de Tecnologia da Saúde de Lisboa. Lisbon.

DOI:

https://doi.org/10.20344/amp.18735

Palavras-chave:

Neoplasias da Paratiroide/diagnóstico por imagem, Hiperparatiroidismo Primário, Ultrassonografia Doppler

Resumo

Introdução: O adenoma da paratiroide é a causa mais frequente de hiperparatiroidismo primário. Nos últimos anos, a localização pré-operatória de adenomas da paratiroide tem permitido técnicas cirúrgicas minimamente invasivas que se tornaram preferíveis à exploração cervical bilateral tradicional. As recomendações internacionais mais recentes relativamente a este tópico têm dado ênfase aos exames de imagem de medicina nuclear. Neste estudo, os autores revêem o papel atual da ecografia cervical com Doppler na localização pré-operatória de adenomas da paratiroide em doentes com hiperparatiroidismo primário.
Material e Métodos: Estudo retrospetivo de doentes com hiperparatiroidismo primário submetidos a paratiroidectomia entre janeiro de 2013 e 2022 no Centro Hospitalar Universitário Lisboa Central. Análise estatística realizada com IBM SPSS Statistics, versão 26.0.0.0®.
Resultados: Foram identificados 171 doentes com hiperparatiroidismo primário submetidos a paratiroidectomia (77,8% sexo feminino). A ecografia cervical com Doppler foi o exame mais solicitado para localização pré-operatória de adenomas da paratiroide (64,3%, n = 110) e detetou a lesão em 98 doentes (89,1%). A análise comparativa da localização pré-operatória do adenoma da paratiroide baseada na ecografia cervical com Doppler com os achados cirúrgicos e histológicos demonstrou identificação correta do adenoma em 76 doentes (77,6%). A ecografia cervical com Doppler subestimou ligeiramente a dimensão dos adenomas (18,1 ± 7,7 mm pré-operatório versus 22 ± 8,4 mm pós-operatório). Os níveis de cálcio, paratormona, a dimensão do adenoma e a presença concomitante de nódulos tiroideus não afetou a eficácia diagnóstica da ecografia cervical com Doppler.
Conclusão: A ecografia cervical com Doppler demonstrou elevada precisão diagnóstica independentemente da presença concomitante de nódulos tiroideus, dos níveis de cálcio e paratormona e da dimensão dos adenomas da paratiroide. A sua disponibilidade, segurança e custo aliado à capacidade diagnóstica demonstrada devem favorecer o seu uso como primeira linha na localização pré-operatória de adenomas da paratiroide no hiperparatiroidismo primário.

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