Management of patients with persistent or recurrent primary hyperparathyroidism.
The surgical management of patients with persistent or recurrent primary hyperparathyroidism is reviewed. The several factors allowing the surgeon to formulate a correct working diagnosis and to successfully remove all abnormal parathyroid tissue are individually discussed and recent results of re-operative parathyroid surgery are presented. In particular, direct surgical exploration based on aggressive pre-operative localization studies, the use of intra-operative ultrasound to facilitate intra-operative dissection, cryopreservation of excised parathyroid tissue with potential for delayed autograft to avoid permanent hypoparathyroidism, and the use of intra-operative monitoring of urinary cyclic adenosine monophosphate levels in patients with parathyroid hyperplasia in whom the surgeon is uncertain whether all abnormal parathyroid tissue has been removed, each contribute to a high rate of successful management (greater than 95%) for patients with the difficult problem of persistent or recurrent primary hyperparathyroidism.
Carty
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Surgical Metabolism Section, National Cancer Institute, Bethesda, Maryland 20892.
Norton
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JA
D015925:Cryopreservation; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D007432:Intraoperative Period; D008722:Methods; D010280:Parathyroid Glands / Q000637:transplantation; D012008:Recurrence; D014463:Ultrasonography