PERSISTENT
OR RECURRENT HYPERPARATHYROIDISM
INDICATIONS
FOR SURGERY
Persistent or
recurrent hyperparathyroidism (HPT) can occur following initial surgery (< 6
months or > 6 months, respectively). Surgery should be considered in these
cases. Preoperative localization studies are mandatory in order to increase
success rate of reoperation. In these cases, ectopic or supernumerary pathologic
parathyroid gland may be present, causing recurrent/persistent HPT. Parathyroid
reoperation is more technically demanding and difficult compared to initial
parathyroidectomy. Morbidity is also higher and for these reasons criteria for
reoperation in patients with recurrent/persistent HPT are more strict than for
the initial parathyroidectomy, and includes major complications of HPT, such
as:
-
Nephrolithiasis
-
Osteoporosis
-
Serum
[Ca++] > 12 mg/dL
-
Hypercalciuria
-
Significant
(> 30 %) decrease of renal creatinine clearance
Because of
the expected difficulties of reoperations for recurrent/persistent HPT, these
procedures should be attempted by high-volume endocrine surgeons.
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