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Review
. 2022 Nov;37(11):2373-2390.
doi: 10.1002/jbmr.4689. Epub 2022 Oct 17.

Surgical Aspects of Primary Hyperparathyroidism

Nancy Perrier  1 , Brian H Lang  2 , Leonardo Costa Bandeira Farias  3 , Leyre Lorente Poch  4 , Mark Sywak  5 , Martin Almquist  6 , Menno R Vriens  7 , Michael W Yeh  8 , Omair Shariq  9 , Quan-Yang Duh  10 , Randy Yeh  11 , Thinh Vu  12 , Virginia LiVolsi  13 , Antonio Sitges-Serra  4
Affiliations
Free article
Review

Surgical Aspects of Primary Hyperparathyroidism

Nancy Perrier et al. J Bone Miner Res. 2022 Nov.
Free article

Abstract

Parathyroidectomy (PTX) is the treatment of choice for symptomatic primary hyperparathyroidism (PHPT). It is also the treatment of choice in asymptomatic PHPT with evidence for target organ involvement. This review updates surgical aspects of PHPT and proposes the following definitions based on international expert consensus: selective PTX (and reasons for conversion to an extended procedure), bilateral neck exploration for non-localized or multigland disease, subtotal PTX, total PTX with immediate or delayed autotransplantation, and transcervical thymectomy and extended en bloc PTX for parathyroid carcinoma. The systematic literature reviews discussed covered (i) the use of intraoperative PTH (ioPTH) for localized single-gland disease and (ii) the management of low BMD after PTX. Updates based on prospective observational studies are presented concerning PTX for multigland disease and hereditary PHPT syndromes, histopathology, intraoperative adjuncts, localization techniques, perioperative management, "reoperative" surgery and volume/outcome data. Postoperative complications are few and uncommon (<3%) in centers performing over 40 PTXs per year. This review is the first global consensus about surgery in PHPT and reflects the current practice in leading endocrine surgery units worldwide. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Keywords: PARATHYROID-RELATED DISORDERS; PTH/VITAMIN D; THERAPEUTICS-OTHER.

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References

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