World Journal of Surgery

, Volume 15, Issue 6, pp 688–692 | Cite as

Surgical treatment of primary hyperparathyroidism: An institutional perspective

  • Jon A. van Heerden
  • Clive S. Grant
Progress Symposium—Hyperparathroldism


Three hundred and eighty-four consecutive patients with primary hyperparathyroidism (HPT) were surgically treated at a single institution during the 2 year period 1983 through 1984. Two patients were found to have benign familial hypocalciuric hypercalcemia and a single patient had parathyroid carcinoma. In the remaining 379 patients, the cure rate was 99.5%, the operative mortality 0.3%, persistent vocal cord paralysis 0.8%, and permanent hypocalcemia 0.3%. This data supports a liberal policy regarding cervical exploration in patients with HPT and questions any policy of observation without surgical intervention.


Hyperparathyroidism Vocal Cord Hypercalcemia Single Institution Operative Mortality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Trois cent quatre-vingt quatre patients consécutifs ayant une hyperparathyroÏdie (HPT) primitive ont été traités dans un seul centre pendant un intervalle de deux ans (1983–1984). Deux patients avaient une hypercalcémie hypocalciurique familiale bénigne et un patient, un cancer de la parathyroÏde. Chez les 379 autres patients, le taux de guérison était de 99.5%, la mortalité de 0.3%, la paralysie permanente des cordes vocales de 0.8% et l'hypocalcémie permanente de 0.3%. Ces données sont en faveur d'une exploration cervicale au moindre chez tout patient avec HPT: l'attitude non-interventionnelle n'est pas justifiée.


Trescientos ochenta y cuatro pacientes consecutivos con hiperparatiroidismo primario (HPT) fueron sometidos a tratamiento quirÚrgico en una sóla institución en el periódo 1983 y 1984. Se hallaron dos pacientes con hipercalcemia hipocalciÚrica familiar y uno con carcinoma paratiroideo. En los restantes 379 pacientes la tasa de curación fue 99.5%, la mortalidad operatoria 0.3%, la parálisis persistente de cuerda vocal 0.8% y la hipocalcemia permanente 0.3%. Estos datos dan apoyo a una política liberal relativa a la exploración cervical en pacientes con HPT y cuestiona la política de observación sin intervención quirÚrgica.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Clark, O.H.: Endocrine surgery of the thyroid and parathyroid glands, St. Louis, C.V. Mosby, 1985, pp 1–378Google Scholar
  2. 2.
    Brown, R.C., Aston, J.P., Weeks, I., Woodhead, J.S.: Circulatory intact parathyroid hormone measured by a two site immunochemiluminometric assay. J. Clin. Endocrinol. Metab.65:407, 1987Google Scholar
  3. 3.
    St. Goar, W.T.: Gastrointestinal symptoms as a clue to the diagnosis of primary hyperparathyroidism: A review of 45 cases. Ann. Intern. Med.46:102, 1957Google Scholar
  4. 4.
    Joborn, C., Hetta, J., Rastad, J., Agren, H., Akerstrom, G., Ljunghall, S.: Psychiatric symptoms and cerebrospinal fluid monoamine metabolites in primary hyperparathyroidism. Biol. Psychiatry23:149, 1988Google Scholar
  5. 5.
    Karstrup, S., Transbol, I., Holm, H.H., Glenthoj, A., Hegedus, L.: Ultrasound-guided chemical parathyroidectomy in patients with primary hyperparathyroidism; A prospective study. Br. J. Radiol.62:1037, 1989Google Scholar
  6. 6.
    van Heerden, J.A., James, E.M., Karsell, P.R., Charboneau, J.W., Grant, C.S., Purnell, D.C.: Small part ultrasonography in primary hyperparathyroidism: Initial experience. Ann. Surg.144:277, 1982Google Scholar
  7. 7.
    Carlson, S.L., Farndon, J.R., Clayton, B., Rose, P.G.: Thallium isotope scintigraphy and ultrasonography: Comparative studies of localization techniques in primary hyperparathyroidism. Br. J. Surg.77:327, 1990Google Scholar
  8. 8.
    Wheeler, M.H., Wade, J.S.H.: Intraoperative identification of parathyroid glands: Appraisal of methylene blue staining. Am. J. Surg.143:713, 1982Google Scholar
  9. 9.
    Welsh, R., Lucas, R.J., Glover, J.L.: Unilateral neck exploration for hyperparathyroidism based on preoperative ultrasonography. Arch. Surg.125:982, 1990Google Scholar
  10. 10.
    Benson, L., Ljunghall, S., Akerstrom, G., Oberg, K.: Hyperparathyroidism presenting as the first lesion in multiple endocrine neoplasia type 1. Am. J. Med.82:731, 1987Google Scholar
  11. 11.
    Roth, S.I., Gallagher, M.J.: The rapid identification of “normal” parathyroid glands by the presence of intracellular fat. Am. J. Pathol.84:521, 1976Google Scholar
  12. 12.
    Wang, C.A., Rieder, S.U.: A density test for the intraoperative differentiation of parathyroid hyperplasia from neoplasia. Ann. Surg.187:63, 1978Google Scholar
  13. 13.
    Brunt, L.M., Wells, S.A.: Parathyroid transplantation: Indications and results. In Common Problems in Endocrine Surgery, J.A. van Heerden editor, Chicago, Year Book Medical Publishers, 1989, pp 214–222Google Scholar
  14. 14.
    Palmer, M., Adami, H.-O., Krusemo, U.B., Ljunghall, S.: Increased risk of malignant diseases after surgery for primary hyperparathyroidism. Am. J. Epidemiol.127:1031, 1988Google Scholar
  15. 15.
    Palmer, M., Adami, H.-O., Bergstrom, R., Akerstrom, G., Ljunghall, S.: Mortality after surgery for primary hyperparathyroidism: A follow-up of 441 patients operated on from 1956 to 1979. Surgery102:1, 1987Google Scholar
  16. 16.
    Palmer, M., Bergstrom, R., Akerstrom, G., Adami, H.-O., Jakobsson, S., Ljunghall, S.: Surgical and renal function in untreated hypercalcemia: Population-based cohort study with 14 years of follow-up. Lancet1:59, 1987Google Scholar

Copyright information

© Société Internationale de Chirurgie 1991

Authors and Affiliations

  • Jon A. van Heerden
    • 1
  • Clive S. Grant
    • 1
  1. 1.Department of SurgeryMayo Clinic and Mayo FoundationRochesterUSA

Personalised recommendations