Perioperative Evaluation of Primary Hyperparathyroidism

Abstract

Primary hyperparathyroidism is most frequently caused by a single adenoma that is amenable to surgical intervention. Knowing the clinical indications for parathyroidectomy and reviewing the imaging studies inform the surgical approach. With an experienced surgeon, the cure rate for primary hyperparathyroidism is very high. Regular monitoring of calcium, albumin, and occasional PTH measurements are required after parathyroidectomy to confirm surgical cure and detect development of hypocalcemia and hypoparathyroidism. There is an increased risk of persistence or recurrence of the hyperparathyroidism if it is associated with inherited syndromes that have multigland involvement. Hypocalcemia is the most common complication following parathyroidectomy and may be associated with a spectrum of clinical manifestations. Hypocalcemia may present with asymptomatic biochemical findings, neuromuscular instability, or more severe findings including laryngospasms, neurocognitive dysfunction, seizures, or heart failure. Oral calcium and vitamin D supplementation are commonly started immediately following parathyroidectomy to prevent hypocalcemia. Severe hypocalcemia is a medical emergency and requires IV calcium administration. The duration and severity of hypocalcemia vary and may depend on the routine use of calcium and vitamin D supplements, degree of injury to remaining parathyroid glands, the severity of the underlying bone disease, and other clinical features like renal dysfunction or hypomagnesemia. Patients can develop prolonged hypocalcemia due to the hungry bone syndrome or permanent hypocalcemia due to the development of hypoparathyroidism.