Primary hyperparathyroidism can be definitively diagnosed on the basis of an elevated serum PTH in hypercalcemic patients without hypocalciuria. Asymptomatic patients with minimal hypercalcemia appear to benefit from successful parathyroidectomy, and 95% of patients can be cured when treated by an experienced endocrine surgeon. Focused exploration and unilateral neck exploration are acceptable when the probability of multiglandular disease is low; the success rate is high if two preoperative localization studies show concordance or a successful localization study is combined with intraoperative PTH monitoring. Bilateral neck exploration, however, remains a safe approach with an excellent success rate. Whether the focused or unilateral exploration is superior to the bilateral approach in success rate, complication rate, or cost-effectiveness remains to be proved by a prospective randomized study.


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