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

• Published in: The Journal of clinical endocrinology and metabolism Vol. 94; no. 2; pp. 366 - 372
• Main Authors: Udelsman, Robert, Pasieka, Janice L, Sturgeon, Cord, Young, J. E. M, Clark, Orlo H
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Bethesda, MD Endocrine Society 01.02.2009
• Subjects: Biological and medical sciences; Consensus; Cost-Benefit Analysis; Diagnostic Imaging - methods; Endocrinopathies; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Humans; Hyperparathyroidism, Primary - economics; Hyperparathyroidism, Primary - surgery; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroidectomy - economics; Parathyroidectomy - methods; Parathyroidectomy - utilization; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Preoperative Care - methods; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; World; Endocrinopathy; Obesity; Nutrition; Nutrition disorder; Metabolic diseases; Asymptomatic; Proceedings; Treatment; Parathyroid diseases; Surgery; Primary; Workshop; Endocrinology; Nutritional status; Hyperparathyroidism; International
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2008-1761

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. Patients with “asymptomatic” disease often have neurocognitive symptoms and bone disease that improve following parathyroidectomy. When performed by expert surgeons, parathyroid surgery is safe and cost-effective.