Opportunistic CT Shows Promise for Identifying Undiagnosed Primary Hyperparathyroidism Risk

An enlarged parathyroid gland indicated increased primary hyperparathyroidism (PHPT) risk, as well as increased risk of pre-existing and incident clinical conditions causally related to PHPT, according to a manuscript published in the American Journal of Roentgenology (AJR).

“Opportunistic CT-based assessment is a promising strategy for identifying patients at increased risk of undiagnosed PHPT,” noted first author Paul M. Bunch, MD, from the radiology department at Wake Forest University School of Medicine in Winston-Salem, NC. “Such assessment could potentially prevent some PHPT-related complications through earlier diagnosis and treatment.”  

This AJR manuscript included patients aged 18 years old or older with at least one contrast-enhanced chest or neck CT performed from January 2012 to December 2012, at least one noncontrast CT covering the chest or neck region without date restriction, and at least one clinical encounter in the health system from January 2022 to December 2022. A neuroradiologist reviewed the CT examinations to determine the presence versus absence of an enlarged parathyroid gland on the 2012 study. Patient demographics, serum calcium results, and diagnosis codes for clinical outcomes causally related to PHPT were extracted from the EHR. Calcium results and diagnosis codes were classified as pre-existing if documented before, and as incident if documented after, the 2012 contrast-enhanced CT examination.

Ultimately, in Bunch et al.’s retrospective cohort study evaluating PHPT-associated morbidity over a decade of follow-up, an enlarged parathyroid gland identified on CT was significantly associated with subsequent PHPT diagnosis (OR 148.01) and development of clinical outcomes causally related to PHPT, including hypercalcemia (OR 7.58), osteopenia or osteoporosis (OR 2.78), and nephrolithiasis (OR 4.95), adjusting for demographic characteristics.