Surgical Interventions for Primary Hyperparathyroidism in Germany, Switzerland, and Austria
Overview
This analysis of 3,291 patients with primary hyperparathyroidism (PHPT) from Germany, Switzerland, and Austria reveals that focused parathyroidectomy guided by preoperative imaging and intraoperative PTH assays is effective. PET-CT showed the highest sensitivity among imaging modalities, especially in re-operations and hereditary cases, while ultrasound and sestamibi scans remain the most frequently used.
Background
Primary hyperparathyroidism is the third most common endocrine disorder, predominantly affecting women over 50 in its sporadic form. Surgical treatment options include focused parathyroidectomy, favored when preoperative localization is successful, and classic parathyroidectomy for negative localization or hereditary disease. The EUROCRINE registry standardizes data collection on endocrine surgeries across Europe, enabling benchmarking and quality improvement. This study analyzes EUROCRINE data from German-speaking countries to assess clinical presentation, diagnostics, surgical management, and outcomes in PHPT.
Data Highlights
Country
Patients (n)
Hereditary Disease (%)
Most Used Imaging
Highest Sensitivity Imaging
Highest PPV Imaging
Germany
1762
2.0%
Ultrasound, Sestamibi
PET-CT (87.5%)
Sestamibi, Ultrasound (91.8%)
Switzerland
971
1.6%
Ultrasound, Sestamibi
PET-CT (92.5%)
PET-CT (95.2%)
Austria
558
1.4%
Ultrasound, Sestamibi
PET-CT (95.3%)
CT (94.1%)
Key Findings
A total of 3,291 patients underwent parathyroidectomy for PHPT across 30 centers in Germany, Switzerland, and Austria.
Hereditary PHPT was rare, accounting for 1.82% of cases overall.
Ultrasound and 99mTc-sestamibi scintigraphy were the most frequently used preoperative imaging modalities.
PET-CT demonstrated the highest sensitivity for localizing adenomas in primary and re-operative settings across all countries.
Positive predictive values varied by country and imaging modality, with PET-CT and CT showing the highest PPVs in re-operations and hereditary disease.
Significant differences were observed between countries in patient age and calcium levels pre- and postoperatively.
Clinical Implications
Focused parathyroidectomy guided by accurate preoperative localization using PET-CT can optimize surgical outcomes in PHPT, especially in re-operative and hereditary cases. Routine use of ultrasound and sestamibi scans remains important for initial evaluation. Awareness of country-specific variations in patient characteristics and imaging performance can inform tailored diagnostic and surgical strategies.
Conclusion
The EUROCRINE registry data from German-speaking countries confirm that multimodal imaging, particularly PET-CT, enhances localization accuracy in PHPT surgery, supporting focused parathyroidectomy as a safe and effective approach. Continued data collection and benchmarking will further improve clinical outcomes.
References
EUROCRINE Registry Data Analysis 2015-2019 -- Surgical Interventions for PHPT
