ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2009) 20 S13.1

Surgery for asymptomatic primary hyperparathyroidism

Jorgen Nordenstrom

Department of Breast- and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden.

Primary hyperparathyroidism (PHPT) is not an uncommon endocrine disease in regions where there are liberal indications for serum calcium measurements. There is a general consensus that virtually all patients with symptomatic PHPT should undergo an operation. The proportion of patients with mild or ‘asymptomatic’ PHPT varies between 40 and 80% in published reports, but a frequent estimate is that about 50% of all PHPT patients belong to this category.

The controversy regarding the role of surgery in asymptomatic PHPT involves a number of medical, social, economical as well as patient preference issues, i.e.,

Will mild neurocognitive symptoms improve after surgery?

What is the effect on bone density and future fracture risk?

Long-term effects on cardio-vascular disease and survival?

Apart from the short- and long-term effects of a cure from the disease, several aspects of the surgical procedure itself need to be taken into account:

The role of pre-operative localisation methods.

The extent of the operation (local-, regional-, or full surgical exploration).

The expertise of the surgeon performing the operation (operative volume for PHPT; success- and operation-specific complication rates).

The patient’s co-morbidity, age and expected life expectancy.

Cost-effectiveness of the operation vs. continued medical observation.

Patient preferences.

The overall analysis of the role of surgery in asymptomatic PHPT patients involves an estimate of the balance between benefits and risks. A surgeon with a special interest and experience with PHPT is probably the best individual to explain the risks, benefits and alternatives to operative intervention.

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