Clinical trial set to provide better outcomes for hyperparathyroidism patients

A groundbreaking new clinical trial at the Royal Brisbane and Women’s Hospital (RBWH) may hold the key for better management of primary hyperparathyroidism, a common endocrine problem that affects approximately 1% of the population at some point in their lives.

Typically impacting women after menopause, if left untreated the condition can cause dangerously high calcium levels, osteoporosis, kidney problems and symptoms like confusion and constipation.

Curing the condition requires surgery – ideally a minimally invasive surgery that can only be attempted once the surgeon knows exactly where the problem parathyroid gland is. This relies on accurate imaging prior to the operation.

The two year clinical trial aims to recruit 134 patients, and will evaluate the benefits of using a PET scan to assess the uptake of a special radiotracer ([18F]fluorocholine) into the parathyroid glands.

This approach may be more precise than the existing imaging techniques which include 4DCT, ultrasound and sestamibi, and is quicker to perform.

RBWH Endocrinologist and University of Queensland PhD student Dr Elizabeth Wootton said there are a range of potential benefits to using this fluorocholine PET/CT scan to help identify the problem parathyroid gland.

“The fluorocholine PET/CT scan emits less radiation than current imaging techniques used for this purpose, and doesn’t require the use of iodinated contrast so is better for patients with contrast allergies or kidney problems,” she said.

“We hope that the trial will lead to more patients with primary hyperparathyroidism being able to receive successful minimally invasive surgery, leading to a better quality of life.”

RBWH Director of Nuclear Medicine Professor David Pattison said the trial is the first of its kind in the world.

“This is the first time a randomised trial is comparing fluorocholine PET/CT to 4DCT has been conducted,” he said.

“I am proud of the large multidisciplinary team delivering this new technology for Queensland patients.”

RBWH Endocrine Surgeon Clement Wong said the clinical trial is very exciting.

“It might be particularly useful for complex parathyroid patients, such as those who have had previous neck surgery or have a genetic condition like MEN1,” Dr Wong said.

The trial has received $244,000 funding from the Queensland Technology Future Fund, and $10,000 from the Royal Australasian College of Physicians, and involves multiple staff groups across the Departments of Nuclear Medicine/QTRaCE, Endocrinology, Endocrinology Surgery and Radiology departments at the RBWH.