Endocrine Abstracts

Primary Hyperparathyroidism (PHPT) is, after diabetes and thyroid diseases, the third commonest endocrine disorder and its incidence and prevalence is rising globally. In the United Kingdom, the incidence of PHPT has been estimated to be 25/100,000, and prevalence has risen from 1.8 to 6.7 per 1000 between 1997-2006, implying that in the UK alone, about half a million people suffer from this condition and 12.000 develop it each year. Recognition of increased PHPT related morbidity and mortality, through links with hypertension, diabetes, cancer, cerebrovascular and cardiovascular events, have widen criteria for surgery in patients previously classified as asymptomatic. As a result, number of parathyroidectomies performed in the UK has doubled with similar trend observed in other countries. Current surgical paradigm for patients with PHPT is based on performing either Bilateral Neck Exploration through large incisions with little or no pre-operative imaging or Minimally Invasive approach with heavy reliance on pre-operative scans. The downside of the former is poor cosmesis, slower recovery, longer operating time and hospital stay, of the latter, overreliance on multiple pre-operative imaging aimed to maximise cure rate. Rising demand for parathyroid surgery, the only treatment able to provide long term cure and prevent or reverse morbidity of PHPT, calls for rationalisation and simplification of existing surgical pathways. In my talk I will explore innovative technologies which can challenge current status quo and increase number of minimally invasive procedures but at the same time decrease number of preoperative scans and improve cure rates but allow for faster completion of surgery. I will also discuss surgical outcomes of parathyroidectomy in adults and children (yes, children can get Primary Hyperparathyroidism too), impact of genetic testing on decision making (interesting and important) and finally, comment (frankly) on new fads in parathyroid surgery posing as progress.