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How to localize parathyroid tumors in primary hyperparathyroidism?

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Abstract

The management of primary hyperparathyroidism (PHPT) has dramatically changed in the last 5 yr. Many more patients now undergo focused, limited or minimally invasive parathyroidectomy instead of traditional bilateral neck exploration. This change has taken place because of the improved accuracy of pre-operative localizing studies in selecting patients who have single-gland parathyroid disease (single adenoma) and can therefore have a minimally invasive parathyroidectomy. Sestamibi scanning followed by ultrasound, magnetic resonance imaging (MRI) and computed tomography (CT) scans are most accurate for localizing parathyroid tumors in patients with PHPT. Selective venous catheterization for PTH levels is useful when other localizing studies are negative or discordant in patients with persistent or recurrent PHPT. The routine use of one or more localizing studies commonly identifies the parathyroid tumor in patients with single-gland disease; but if localizing studies are negative or discordant, patients should have intra-operative PTH levels monitored or have a bilateral neck exploration to ensure a high rate of biochemical cure.

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Authors and Affiliations

  1. San Francisco Mount Zion Medical Center, Department of Surgery, University of California, 1600 Divisadero Street, Box 1674, San Francisco, CA, 94118

    T. Uruno & E. Kebebew MD

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  1. T. Uruno
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  2. E. Kebebew MD
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Correspondence to E. Kebebew MD.

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Uruno, T., Kebebew, E. How to localize parathyroid tumors in primary hyperparathyroidism?. J Endocrinol Invest 29, 840–847 (2006). https://doi.org/10.1007/BF03347381

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