We report a retrospective study of 50 cases of primary hyperparathyroidism (10 men and 40 women, mean age: 49 years) collected between 1975 and 2004. At the time of diagnosis, 44% of patients had bone disease, renal manifestations were present in 17 cases (34%).
Parathyroidectomy is a safe and effective approach of primary hyperparathyroidism treatment. The management of persistent or recurrent hyperparathyroidism is explained by the fact that parathyroid hyperplasia or carcinoma, ectopic or supernumerary parathyroid tissues are more common in this population. Ultrasonography was performed in 36 cases, it correctly located tumors in normal position in 24 case (66%).
42 patients underwent parathyroidectomy. Surgeons performed unilateral exploration guided by preoperative localization, with controlateral exploration only if hyperplasia is identified.
In 37 cases, only one enlarged gland was removed (36 parathyroid adenomas and a case of parathyroid carcinoma). In 4 patients suspected of having hyperplasia, removal of all enlarged glands (2 in each case) was made. No serious complications of surgery are noted. All symptoms were improved and serum PTH returned to the normal range in 40 successful resections. Persistent disease is noted in 2 unilateral explored cases. Although discordance in results of ultrasonography, magnetic resonance imaging and sestamibi scanning, lesion is located in the two cases of persistent disease. Successtul reoperation is performed in one case.
The only opportunity for efficient cure of primary hyperparathyroidism is surgical removed of the abnormal gland or glands. The incidence of failed initial parathyroidectomy can be reduced if bilateral cervical exploration is performed by an experienced surgeon.
01 - 05 Apr 2006
European Society of Endocrinology