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Surgery for Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop

Carmalt Professor of Surgery and Oncology (R.U.), Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510; Clinical Professor of Surgery and Oncology (J.L.P.), Department of Surgery, University of Calgary, Calgary, Alberta, Canada AB T2N 1N4; Director of Endocrine Surgery (C.S.), Northwestern University, Department of Surgery, Chicago, Illinois 60611; Head of Surgical Oncology (J.E.M.Y.), St. Joseph’s Healthcare Clinical Professor of Surgery, McMaster University, Hamilton, Ontario, Canada L8S 4L8; and UCSF/Mt. Zion Medical Center (O.H.C.), Department of Surgery, University of California, San Francisco, California 94143

Address all correspondence and requests for reprints to: Robert Udelsman, M.D., M.B.A., Carmalt Professor of Surgery and Oncology, Chairman, Department of Surgery, Yale University School of Medicine, P.O. Box 208062, New Haven, Connecticut 06520-8062. E-mail: Robert.Udelsman{at}yale.edu.

Context: An international workshop on primary hyperparathyroidism (PHPT) was convened on May 13, 2008, to review and update the previous summary statement on the management of asymptomatic PHPT published in 2002.

Evidence Acquisition: Electronic literature sources were systematically reviewed, addressing critical aspects of the surgical issues pertaining to the indications, imaging, surgical treatment, and cost-effective management of patients with PHPT.

Evidence Synthesis: The surgical group concluded that many patients with "asymptomatic" PHPT have neurocognitive symptoms that may be unmasked after successful parathyroidectomy. Furthermore, reduced bone density and increased fracture risk can be improved with parathyroidectomy. When PHPT is symptomatic, it may be associated with nephrolithiasis, increased cardiovascular disease, and decreased survival. Preoperative imaging studies should only be performed to help plan the operation, and negative imaging should never preclude surgical referral. Noninvasive localization studies including ultrasound and sestamibi scans are often employed, especially in anticipation of focused explorations. Invasive localization studies should be reserved for remedial explorations where noninvasive imaging has been unsuccessful.

Conclusions: When performed by expert parathyroid surgeons, parathyroid surgery is safe, cost-effective, and associated with very low perioperative morbidity. Minimally invasive approaches to parathyroid surgery appear to be as effective as the classic bilateral cervical exploration approach.

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				J. P. Bilezikian, A. A. Khan, J. T. Potts Jr, and on behalf of the Third International Workshop on t Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Third International Workshop J. Clin. Endocrinol. Metab., February 1, 2009; 94(2): 335 - 339. [Abstract] [Full Text] [PDF]