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Surgical Treatment of Primary Hyperparathyroidism: Description of Techniques and Advances in the Field

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Abstract

Primary hyperparathyroidism is a disease commonly seen in patients above 60 years of age. It is the most common cause of asymptomatic or symptomatic hypercalcemia, usually found incidentally on routine check-ups. Surgical treatment is the only definitive treatment of choice in the symptomatic patient; however, it can also be employed in asymptomatic patients. First described in 1925, bilateral neck exploration is the gold standard of treatment for primary hyperparathyroidism. The recent interest in minimally invasive surgeries has led to better and improved techniques of neck exploration with improved cosmetic results and lesser chances of transient or permanent hypoparathyroidism due to inadvertent removal of normally functioning parathyroid tissue. These include unilateral neck explorations, minimally invasive parathyroidectomies and minimally invasive radio-guided parathyroidectomy. The intact parathyroid hormone assays have greatly added to the detection of normal and abnormal functioning glands, hence better surgical outcomes.

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Abbreviations

iPTH:

Intact parathyroid hormone

MIRP:

Minimally invasive radio-guided parathyroidectomy

PTH:

Parathyroid hormone

MEN:

Multiple endocrine neoplasia

CT:

Computed tomography

MRI:

Magnetic resonance imaging

U/S:

Ultrasonography

IRMA:

Immunoradiometric assay

IOPTH:

Intraoperative parathyroid hormone assay

ICMA:

Immunochemiluminometric assay

BMD:

Bone mineral density

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Correspondence to Muhammad Adil Abbas Khan.

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Khan, M.A.A., Rafiq, S., Lanitis, S. et al. Surgical Treatment of Primary Hyperparathyroidism: Description of Techniques and Advances in the Field. Indian J Surg 76, 308–315 (2014). https://doi.org/10.1007/s12262-013-0898-0

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