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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Suggested Reading
Bilezikian JP, Brandi ML, Eastell R, Silverberg SJ, Udelsman R, Marcocci C, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metabol. 2014;99(10):3561–9.
Jain N, Reilly RF. Hungry bone disease. Curr Opin Nephrol Hypertens. 2017;26(4):250–5.
Stack BC Jr, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, et al. American association of clinical endocrinologists and American college of endocrinology disease state clinical review: postoperative hypoparathyroidism–definitions and management. Endocr Pract. 2015;21(6):674–85.
Udelsman R, Akerstrom G, Biagini C, Duh QY, Miccoli P, Niederle B, et al. The surgical management of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metabol. 2014;99(10):3595–606.
Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, et al. The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151(10):959–68.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Pallais, J.C. (2020). Perioperative Evaluation of Primary Hyperparathyroidism. In: Garg, R., Hennessey, J., Malabanan, A., Garber, J. (eds) Handbook of Inpatient Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-030-38976-5_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-38976-5_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-38975-8
Online ISBN: 978-3-030-38976-5
eBook Packages: MedicineMedicine (R0)