Primary hyperparathyroidism, adrenal tumors and neuroendocrine tumors of the pancreas -: clinical diagnosis and imaging requirements

Introduction. Diseases of the parathyroids, the adrenals and of neuroendocrine tumors of the pancreas are primarily diagnosed by clinical and endocrinological evaluation. The requirements concerning various imaging techniques and their relative importance in localization strategies of the different tumors are complex. Materials and methods. Current literature search, using PubMed. Results. Evaluation of primary hyperparathyroidism requires bone densitometry by DXA and search for nephrolithiasis by ultrasound or native CT examination. While ultrasound of the thyroid and parathyroids seems useful before any parathyroid surgery, more extensive preoperative localization strategies (sestamibi scintigraphy, MRI) should be restricted to minimal invasive parathyroid surgery or reoperations. For adrenal tumors CT and MRI are of similar diagnostic value. Imaging of pheochromocytomas should be completed by MIBG scintigraphy. Each adrenal incidentaloma requires an endocrinological work-up. A fine-needle aspiration or core needle biopsy of an adrenal tumor is rarely indicated. Before adrenal biopsy a pheochromocytoma has to be excluded. Successful localization strategies for neuroendocrine tumors of the pancreas include somatostatin receptor scintigraphy, endoscopic ultrasound and MRI. Discussion. Specific localization strategies have been established for the aforementioned tumors. The continuous progress of different imaging techniques requires a regular reevaluation of these localization strategies.