Conclusion

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.

REFERENCES

1. NIH conference. Diagnosis and management of asymptomatic primary hyperparathyroidism: Consensus development conference statement. Ann Intern Med 1991 ;114:593.

2. Bartsch D, Nies C, Hasse C, et al. Clinical and surgical aspects of double adenoma in patients with primary hyperparathyroidism. Br J Surg 1995;82:926.

3. Schneider AB, Gierlowski TC, Shore-Freedman E, et al. Dose-response relationships for radiation-induced hyperparathyroidism. J Clin Endocrinol Metab 1995;80:254.

4. Tezelman S, Rodriguez JM, Shen W, et al. Primary hyperparathyroidism in patients who have received radiation therapy and in patients who have not received radiation therapy. J Am Coll Surg 1995;180:81.

5. Hosokawa Y, Pollak MR, Brown EM, Arnold A. Mutational analysis of the extracellular Ca2+-sensing receptor gene in human parathyroid tumors. J Clin Endocrinol Metab 1995;80:3107

6. Cryns VL, Thor A, Xu HJ, et al. Loss of the retinoblastoma tumor-suppressor gene in parathyroid carcinoma. N Engl J Med 1994; 330:757.

7. Hakim JP, Levine MA. Absence of p53 point mutations in parathyroid adenoma and carcinoma. J Clin Endocrinol Metab 1994;78:103.

8. Shattuck TM, Valimaki S, Obara T, et al. Somatic and germ-line mutations of the HRPT2 gene in sporadic parathyroid carcinoma. N Engl J Med 2003;349:1722.

9. Libutti SK, Crabtree JS, Lorang D, et al. Parathyroid gland-specific deletion of the mouse Menl gene results in parathyroid neoplasia and hypercalcemic hyperparathyroidism. Cancer Res 2003;63:8022.

10. Hamby LS, Lee EY, Schwartz RW. Parathyroid adenoma and gastric carcinoma as manifestations of Cowden's disease. Surgery 1995; 118:115.

11. Cavanah SF, Dons RF. McCune-Albright syndrome: How many endocrinopathies can one patient have? South Med J 1993;86:364.

12. Pearce SH. Clinical disorders of extracellular calcium-sensing and the molecular biology of the calcium-sensing receptor. Ann Med 2002;34:201.

13. Deftos LJ. Hypercalcemia in malignant and inflammatory diseases. Endocrinol Metab Clin North Am 2002;31:141.

14. Eigelberger MS, Cheah WK, Ituarte PH, et al. The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: Are they too limited? Ann Surg 2004;239:528.

15. Chan AK, Duh QY, Katz MH, et al. Clinical manifestations of primary hyperparathyroidism before and after parathyroidectomy: A case-control study. Ann Surg 1995;222:402.

16. Siperstein AE, Shen W, Chan AK, et al. Normocalcemic hyperparathyroidism: Biochemical and symptom profiles before and after surgery. Arch Surg 1992;127:1157.

17. Hedback G, Oden A, Tisell LE. Parathyroid adenoma weight and the risk of death after treatment for primary hyperparathyroidism. Surgery 1995; 117:134.

18. Ogard CG, Engholm G, Almdal TP, Vestergaard H. Increased mortality in patients hospitalized with primary hyperparathyroidism during the period 1977-1993 in Denmark. World J Surg 2004;28:108.

19. Chou FF, Sheen-Chen SM, Leong CP. Neuromuscular recovery after parathyroidectomy in primary hyperparathyroidism. Surgery 1995; 117:18.

20. Solomon BL, Schaaf M, Smallridge RC. Psychologic symptoms before and after parathyroid surgery. Am J Med 1994;96:101.

21. Jabbour N, Corvilain J, Fuss M, et al. The natural history of renal stone disease after parathyroidectomy for primary hyperparathyroidism. Surg Gynecol Obstet 1991; 172:25.

22. Stefenelli T, Mayr H, Bergler-Klein J, et al. Primary hyperparathyroidism: Incidence of cardiac abnormalities and partial reversibility after successful parathyroidectomy. Am J Med 1993;95:197.

23. Silverberg SJ, Gartenberg F, Jacobs TP, et al. Increased bone mineral density after parathyroidectomy in primary hyperparathyroidism. J Clin Endocrinol Metab 1995;80:729.

24. Pasieka JL, Parsons LL, Demeure MJ, et al. Patient-based surgical outcome tool demonstrating alleviation of symptoms following parathyroidectomy in patients with primary hyperparathyroidism. World J Surg 2002;26:942.

25. Malmaeus J, Granberg PO, Halvorsen J, et al. Parathyroid surgery in Scandinavia. Acta Chir Scand 1988; 154:409.

26. Shen W, Duren M, Morita E, et al. Reoperation for persistent or recurrent primary hyperparathyroidism. Arch Surg 1996;131:861; discussion 867.

27. Weber CJ, Sewell CW, McGarity WC. Persistent and recurrent sporadic primary hyperparathyroidism: Histopathology, complications, and results of reoperation. Surgery 1994;116:991.

28. Doherty GM, Weber B, Norton JA. Cost of unsuccessful surgery for primary hyperparathyroidism. Surgery 1994;116:954.

29. Oertli D, Richter M, Kraenzlin M, et al. Parathyroidectomy in primary hyperparathyroidism: Preoperative localization and routine biopsy of unaltered glands are not necessary. Surgery 1995;117:392.

30. Roe SM, Burns RP, Graham LD, et al. Cost-effectiveness of preoperative localization studies in primary hyperparathyroid disease. Ann Surg 1994;219:582.

31. Prinz RA, Lonchyna V, Camaille B, et al. Thoracoscopic excision of enlarged mediastinal parathyroid glands. Surgery 1994;116:999.

32. Uden P, Chan A, Duh QY, et al. Primary hyperparathyroidism in younger and older patients: Symptoms and outcome of surgery. World J Surg 1992;16:791.

33. Milas M, Wagner K, Easley KA, et al. Double adenomas revisited: Nonuniform distribution favors enlarged superior parathyroids (fourth pouch disease). Surgery 2003; 134:995; discussion 1003.

34. Duh QY, Ciulla TA, Clark OH. Primary parathyroid hyperplasia associated with thyroid hemiagenesis and agenesis of the isthmus. Surgery 1994; 115:257.

35. Kraimps JL, Duh QY, Demeure M, Clark OH. Hyperparathyroidism in multiple endocrine neoplasia syndrome. Surgery 1992; 112:1080.

36. Feliciano DV. Parathyroid pathology in an intrathyroidal position. Am J Surg 1992;164:496.

37. Rodriguez JM, Tezelman S, Siperstein AE, et al. Localization procedures in patients with persistent or recurrent hyperparathyroidism. Arch Surg 1994;129:870.

38. Carty SE, Worsey J, Virji MA, et al. Concise parathyroidectomy: The impact of preoperative SPECT 99mTc sestamibi scanning and intraoperative quick parathormone assay. Surgery 1997; 122:1107; discussion 1114.

39. Irvin GL 3rd, Dembrow VD, Prudhomme DL. Clinical usefulness of an intraoperative "quick parathyroid hormone" assay. Surgery 1993;114:1019; discussion 1022.

40. Wang CA. Unilateral neck exploration for primary hyperparathyroidism. Arch Surg 1990;125:985.

41. Haciyanli M, Lai G, Monta E, et al. Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg 2003:197:739.

42. Arici C, Cheah WK, Ituarte PH, et al. Can localization studies be used to direct focused parathyroid operations? Surgery 2001;129:720.

43. Wei JP, Burke GJ. Analysis of savings in operative time for primary hyperparathyroidism using localization with technetium 99m sestamibi scan. Am J Surg 1995:170:488.

44. Proye CA, Carnaille B, Bizard JP, et al. Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited: Where are we in the early 1990s? A plea against unilateral parathyroid exploration. Surgery 1992;! 12:1118.

45. Carneiro DM, Irvin GL 3rd. Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration. Surgery 2000;128:925;discussion 935.

46. Heller KS, Attie JN, Dubner S. Parathyroid localization: Inability to predict multiple gland involvement. Am J Surg 1993:166:357.

47. Thompson GB, Mullan BP, Grant CS, et al. Parathyroid imaging with technetium-99m-sestamibi: An initial institutional experience. Surgery 1994:116:966.

48. Weber CJ, Ritchie JC. Retrospective analysis of sequential changes in serum intact parathyroid hormone levels during conventional parathyroid exploration. Surgery 1999:126:1139; discussion 1143.

49. Kao PC, van Heerden JA, Taylor RL. Intraoperative monitoring of parathyroid procedures by a 15-minute parathyroid hormone immuno-chemiluminometric assay. Mayo Clin Proc 1994;69:532.

50. Arnold A, Brown MF, Urena P, et al. Monoclonality of parathyroid tumors in chronic renal failure and in primary parathyroid hyperplasia. J Clin Invest 1995:95:2047.

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