Effect of calcium channel blockers on the sensitivity of preoperative ^99mTc-MIBI SPECT for hyperparathyroidism

Technetium 99m (^99mTc)-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) is frequently used in the evaluation of patients with hyperparathyroidism. Calcium channel blockers (CACBs) may affect ^99mTc-MIBI uptake by parathyroid cells. This study examines the effect of CACB therapy on the sensitivity of ^99mTc-MIBI SPECT localization for hyperparathyroidism. Two hundred fifty-three operated patients with hyperparathyroidism were retrospectively reviewed. The potential effect of CACB therapy on ^99mTc-MIBI scan sensitivity was examined by using logistic regression analysis. Possible confounding factors were considered. Among 235 patients, those with multiple endocrine neoplasia, type I (MEN-I), MEN-IIA, 4-gland hyperplasia, secondary hyperparathyroidism, and tertiary hyperparathyroidism exhibited no difference associated with CACB use. Of the remaining 198 patients with primary hyperparathyroidism, 7/30 (23%) with negative ^99mTc-MIBI SPECT scans compared to 24/168 (14%) with positive scans used CACBs. After correcting for age, gender and gland weight, the odds ratio (OR) for a negative study in patients taking CACBs was 2.88 (95% CI, 1.03-8.10; P=. 045). Atherosclerosis, hypertension, diabetes mellitus, preoperative calcium and parathyroid hormone levels, and thyroid hormone use were not confounding factors. CACB therapy reduces the sensitivity of ^99mTc-MIBI parathyroid SPECT in patients with primary hyperparathyroidism. Further studies are required to determine the potential reversibility of this effect with termination of CACB therapy.