Current Indications and Decision-making Leading to Parathyroidectomy: A Surgical Viewpoint

Abstract

Primary hyperparathyroidism (PHPT) is caused by a parathyroid adenoma in 85%, parathyroid hyperplasia in 15%, and parathyroid carcinoma in less than 1% of patients. This disease is classically described by the pentad of painful bones, renal stones, abdominal groans, psychic moans, and fatigue overtones. Today about 20% of patients referred for parathyroidectomy have renal stones, 30% have osteopenia or osteoporosis, and about 2% have osteitis fibrosa cystica. There are now three different presentations for PHPT: symptomatic, minimally symptomatic, and asymptomatic. PHPT is currently diagnosed by biochemical testing with an elevated serum calcium, an elevated or non-suppressed parathyroid hormone level, and the absence of hypocalciuria. Given the wide spectrum of disease that is diagnosed based on biochemical markers, the NIH made specific recommendations for the treatment of the non-classical PHPT. Many experts in this field have challenged these recommendations because numerous long-term follow-up investigations have shown the detrimental effects of hyperparathyroidism on bone density and fracture rate, renal function, cardiovascular mortality, and neuropsychiatric function. Parathyroidectomy is the only curative treatment for PHPT with a success rate of about 95%.