Current concepts in the management of primary hyperparathyroidism Journal Article
| Authors: | Iyer, N. G.; Shaha, A. R. |
| Article Title: | Current concepts in the management of primary hyperparathyroidism |
| Abstract: | Primary hyperparathyroidism is the commonest cause of hypercalcemia in the ambulatory setting. Widespread use of routine laboratory screening has resulted in a large number of patients presenting with subclinical disease. In truly asymptomatic patients, consensus guidelines have been developed to determine which patients need definitive treatment. The most common pathologic finding is parathyroid adenoma, followed by hyperplasia, double adenomas and parathyroid carcinoma. The mainstay of treatment is surgery. While there is still an important role for four gland exploration and evaluation, there is now considerable interest in a more focused surgical approach. This paradigm shift is based on localizing studies that combine sestamibi scanning with anatomic imaging, most commonly ultrasound scanning. A range of minimally invasive approaches have been developed to treat parathyroid adenomas, including unilateral and single gland explorations as well as a number of different endoscopic techniques. Intra-operative rapid parathormone assay has replaced histologic examination as a more effective method to confirm the adequacy of surgery in most cases. Functional localization and exploration using a gamma probe has also been described. The management of patients with persistent or recurrent hyperparathyroidism is difficult and requires a multidisciplinary approach. © 2010 Indian Association of Surgical Oncology. |
| Keywords: | treatment failure; review; pathophysiology; nuclear magnetic resonance imaging; positron emission tomography; computer assisted tomography; clinical assessment; calcium; creatinine; calcium blood level; hypercalcemia; biopsy; histology; echography; endoscopic surgery; general anesthesia; methoxy isobutyl isonitrile technetium tc 99m; hyperparathyroidism; malignant neoplastic disease; parathyroid adenoma; single photon emission computer tomography; hematoma; frozen section; parathyroid hormone; parathyroid hormone blood level; surgical anatomy; thiazide diuretic agent; sarcoidosis; angiography; creatinine clearance; hypocalcemia; intra-operative; parathyroid carcinoma; parathyroid gland; minimally invasive procedure; paget bone disease; parathyroidectomy; primary hyperparathyroidism; sestamibi; pth; calcium urine level; laryngeal nerve injury; milk alkali syndrome; vein catheterization; vitamin d intoxication |
| Journal Title: | Indian Journal of Surgical Oncology |
| Volume: | 1 |
| Issue: | 2 |
| ISSN: | 0975-7651 |
| Publisher: | Springer India |
| Date Published: | 2010-01-01 |
| Start Page: | 112 |
| End Page: | 119 |
| Language: | English |
| DOI: | 10.1007/s13193-010-0023-9 |
| PROVIDER: | scopus |
| PMCID: | PMC3421003 |
| PUBMED: | 22930625 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 August 2012" - "Source: Scopus" |
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