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Parathyroid exploration for primary hyperparathyroidism

Authors
Nancy D Perrier, MD, FACS
Paxton V Dickson, MD
Angelica Silva Figueroa, MD
Section Editors
Sally E Carty, MD, FACS
Clifford J Rosen, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Primary hyperparathyroidism (PHPT) is most commonly diagnosed when hypercalcemia is detected incidentally on routine biochemical screening [1]. However, hyperparathyroidism and hypercalcemia can lead to symptoms such as nephrolithiasis and osteoporosis. Parathyroidectomy provides definitive therapy for PHPT and is recommended for all patients with symptomatic and familial disease and selected patients with asymptomatic disease.

The surgical treatment for PHPT will be reviewed here. The medical management of hyperparathyroidism, surgical anatomy of the parathyroid glands, multiple endocrine neoplasia type 1, and the role of preoperative localization and intraoperative parathyroid hormone assay are discussed elsewhere. (See "Surgical anatomy of the parathyroid glands" and "Preoperative localization for parathyroid surgery in patients with primary hyperparathyroidism" and "Primary hyperparathyroidism: Management" and "Multiple endocrine neoplasia type 1: Clinical manifestations and diagnosis" and "Intraoperative parathyroid hormone assays".)

INDICATIONS

Once a diagnosis of primary hyperparathyroidism (PHPT) has been made biochemically, a decision regarding surgical intervention versus observation must be made. That decision varies depending on whether the patient is symptomatic, is asymptomatic, or has familial disease. (See "Primary hyperparathyroidism: Management".)

Symptomatic PHPT — Surgical intervention is indicated for all patients with symptomatic PHPT [2]. Clinical manifestations of hyperparathyroidism include [2,3] (see "Primary hyperparathyroidism: Clinical manifestations"):

Polydipsia and polyuria.

                                                           
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Literature review current through: Nov 2017. | This topic last updated: May 25, 2017.
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