Summary: A study in the American Journal of Roentgenology found that CT-detected enlarged parathyroid glands are strongly associated with higher risks of primary hyperparathyroidism and related conditions, highlighting the potential of early CT-based assessment to improve diagnosis and prevent complications.

Key Takeaways

  • Enlarged Parathyroid Glands Linked to PHPT: CT-detected enlargement strongly correlates with higher PHPT risk and related conditions.
  • CT Imaging May Prevent Complications: Opportunistic CT assessment can aid early diagnosis and treatment of PHPT.
  • Study Validates CT’s Diagnostic Role: Decade-long data confirms CT’s value in identifying PHPT risks.

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An accepted manuscript in the American Journal of Roentgenology (AJR) found that an enlarged parathyroid gland is associated with a higher risk of primary hyperparathyroidism (PHPT) and related clinical conditions, both pre-existing and newly developed.

“Opportunistic CT-based assessment is a promising strategy for identifying patients at increased risk of undiagnosed PHPT,” says first author Paul M. Bunch, MD, an associate professor of radiology 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.”  

Parathyroid Glands Linked to PHPT Risk

The AJR manuscript analyzed patients aged 18 or older who had at least one contrast-enhanced chest or neck CT from January to December 2012, a noncontrast CT of the same region (no date restriction), and a clinical encounter between January and December 2022.

A neuroradiologist reviewed the 2012 CT scans for the presence of an enlarged parathyroid gland. Data on patient demographics, serum calcium levels, and diagnosis codes for conditions linked to PHPT were extracted from the electronic health record. Calcium results and diagnosis codes were categorized as pre-existing if recorded before the 2012 CT and as incident if recorded after.

In Bunch and his colleagues’ retrospective cohort study, an enlarged parathyroid gland detected on CT was strongly associated with subsequent PHPT diagnosis (OR 148.01) and PHPT-related conditions, including hypercalcemia (OR 7.58), osteopenia or osteoporosis (OR 2.78), and nephrolithiasis (OR 4.95), after adjusting for demographic factors.

Featured image: Left: Axial image from contrast-enhanced CT of neck shows central compartment soft-tissue nodule (arrow) that measures larger than 7 mm and has enhancement characteristics different from lymph nodes. Right: Corresponding axial noncontrast image shows that soft-tissue nodule (arrow) is hypoattenuating relative to normal thyroid (asterisk), consistent with enlarged parathyroid gland.