ASYMPTOMATIC
PRIMARY HYPERPARATHYROIDISM – RESULTS OF SURGICAL VS. NON-SURGICAL MANAGEMENT
In
evaluating results of management of primary hyperparathyroidism (PHPT),
outcomes such as bone disease and biochemical abnormalities should be analyzed.
Surgical treatment has an immediate effect, improving bone density and may
ameliorate some vague symptoms which affect quality of life. In patients with
PHPT treated nonoperatively, disease will progress in about one-third of them over
the first years of observation (as evidenced by worsening of hypercalcemia,
hypercalciuria, newly diagnosed nephrolithiasis etc). In nonoperative management,
follow-up of patients is indicated and the tests may ultimately exceed the cost
of surgery. Despite that surgical intervention criteria have been proposed in
patients with asymptomatic PHPT, a significant percentage of them who do not
meet these criteria may still choose parathyroidectomy, because it is the only
definitive treatment. Patient’s age is an important consideration. Clearly
surgery should be considered in young patients (< 50 yrs.). Modern
preoperative localization tests allow a minimally invasive approach (focused parathyroidectomy).
Parathyroidectomy should be performed by highly experienced endocrine surgeons,
in order to achieve definitive and safe cure of PHPT during the initial
procedure, thereby avoiding reoperations in the future for persistent /
recurrent PHPT.
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