title: Defining failure after parathyroidectomy for primary hyperparathyroidism: case series.
abstract: OBJECTIVE
  To identify the cause of operative failure in patients who have undergone parathyroid surgery for primary hyperparathyroidism.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Patients who had undergone a primary procedure for primary hyperparathyroidism between July 2003 and December 2007. Cases with incomplete post-operative serum calcium data were excluded.
  
  
  METHODS
  Operative failure was defined as failure to achieve normalisation of serum adjusted calcium levels post-operatively.
  
  
  RESULTS
  A total of 220 primary procedures were conducted over 4.5 years. Data were not available for 16 patients. Thirteen procedures (6.4 per cent) were considered failures, and these cases were individually reviewed and classified according to the reason for failure.
  
  
  CONCLUSIONS
  Establishing the cause of failure following surgery for primary hyperparathyroidism can be a complex task. In some instances, diagnostic uncertainty remains despite detailed biochemical and radiological assessment. This paper outlines our approach to maximising the cure rate at primary surgery.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Hull Royal Infirmary, UK. sdcharlett@doctors.org.uk
authors.forename: S D
authors.initials: SD
authors.lastname: Charlett
authors.forename: M
authors.initials: M
authors.lastname: Aye
authors.forename: S L
authors.initials: SL
authors.lastname: Atkin
authors.forename: R J A
authors.initials: RJ
authors.lastname: England
mesh_terms: D000236:Adenoma / Q000175:diagnosis; D000328:Adult; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006934:Hypercalcemia / Q000151:congenital / Q000175:diagnosis / Q000209:etiology; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006965:Hyperplasia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000175:diagnosis; D016105:Parathyroidectomy / Q000379:methods*; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium