title: Surgery for asymptomatic primary hyperparathyroidism: proceedings of the third international workshop.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA. Robert.Udelsman@yale.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Udelsman
authors.forename: Janice L
authors.initials: JL
authors.lastname: Pasieka
authors.forename: Cord
authors.initials: C
authors.lastname: Sturgeon
authors.forename: J E M
authors.initials: JE
authors.lastname: Young
authors.forename: Orlo H
authors.initials: OH
authors.lastname: Clark
mesh_terms: D032921:Consensus; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000191:economics / Q000601:surgery*; D016105:Parathyroidectomy / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods