Original Articles

Our Clinical Experience in Primary Hyperparathyroidism - Original Article

  • Mehmet Gülen
  • Orçun Oral Şentürk
  • Muzaffer Akıncı
  • Adil Koyuncu
  • Adem Duru

Med Bull Haseki 2005;43(3):0-0

In this study we aimed to evaluate the results of surgical treatment of 15 patients who were treated for primary hyperparathyroidism and followed up in the outpatient clinic of our hospital between 1996-2004. All the patients were women with a mean age of 55.4 (between 35-73 years). The mean follow-up time was 8.6 months (between 3-17 months). The mean period of time since onset of symptoms till diagnosis was 21.6 months (between 3-48 months). All the patients had osteodystrophic changes. There were not any asymptomatic patient in our study group. Preoperative localisation studies included ultrasonography (USG), magnetic resonance imaging (MRI) and Tc -sesta MIBI 99m scintigraphy (Sg). One staged initial operation was enough in 11 patients, whereas a second operation was needed in 4 patients. In conclusion, primary hyperparathyroidism is still an underestimated disease in Turkey and patients are rarely asymptomatic due to delayed diagnosis. According to the western literature however, most of the patients are reported to be asymptomatic. Patients do feel better but they are rarely free of symptoms after surgery. Surgery should be offered even to the asymptomatic patients, because the treatment of possible future complications might be extremely difficult. Against all these surgery still remains as the only treatment modality for primary hyperparathyroidism.

SummaryIn this study we aimed to evaluate the results of surgical treatment of 15 patients who were treated for primary hyperparathyroidism and followed up in the outpatient clinic of our hospital between 1996-2004. All the patients were women with a mean age of 55.4 (between 35-73 years). The mean follow-up time was 8.6 months (between 3-17 months). The mean period of time since onset of symptoms till diagnosis was 21.6 months (between 3-48 months). All the patients had osteodystrophic changes. There were not any asymptomatic patient in our study group. Preoperative localisation studies included ultrasonography (USG), magnetic resonance imaging (MRI) and Tc -sesta MIBI 99m scintigraphy (Sg). One staged initial operation was enough in 11 patients, whereas a second operation was needed in 4 patients. In conclusion, primary hyperparathyroidism is still an underestimated disease in Turkey and patients are rarely asymptomatic due to delayed diagnosis. According to the western literature however, most of the patients are reported to be asymptomatic. Patients do feel better but they are rarely free of symptoms after surgery. Surgery should be offered even to the asymptomatic patients, because the treatment of possible future complications might be extremely difficult. Against all these surgery still remains as the only treatment modality for primary hyperparathyroidism.Key words: Primary hyperparathyroidism, imaging studies, symptoms

Article in Turkish(Use the link for full-text in Turkish)


1. Clark OH. Surgical treatment of primary hyperparathyroidism. Adv Endocrinol Metab 1995;6:1-16.
2. Heath H, Hodgson SF, Kenedy MA. Primary hyperparathyroidism. Incidence, morbidity and potential economic impact in a community. N Engl J Med 1992;302:189-93.
3. Potts JT Jr. Management of asymptomatic hyperparathyroidism: a report on the NIH consensus development conference. Trends Endocrinol Metab 1992;10:376-80.
4. Fischer JA. "Asymptomatic" and symptomatic primary hyperparathyroidism. Clin Investig 1993;71:505-18.
5. Breslau NA, Pak CYC. Asymptomatic primary hyperparathyroidism. "Disorders of bone and mineral metabolism" Ed.Coe FC, Favus MF, Raven Press, New York 1992;523-35.
6. Aparwal G, Mishra SK, Kar DK, Singh AK, Arya V, Gupto SK, Mithal A. Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy. Surgery 2002;132(6):1075-85.
7. Silverberg S, Since E, Jacobs T, Siris E. 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery. The New Eng J Med 199; 341: 1249-55.
8. Mack LA, Paseika JL. Asymptomatic primary hyperparathyroidizm: a surgical perspective. Surg Clin North Am 2004;84 (3):803-16.
9. Sofferman RA, Standage J, Tang ME. Minimal access parathyroid surgery using intraoperative parathyroid hormone assay. Laryngoscope 1998;108(10):1497-503.
10. Elanj DM, Remaley AT, Simonds WF, Skarulis NC, Libutti SK, Barkett DL, Venzon DJ, Marx SJ, Alexander HR. Utility of rapid intraoperative parathyroid hormone assay to predict severe postoperative hypocalcemia after reoperation for hyperparathyroidism. Surgery 2002;132(6):1028 -34.
11. Ficinski MD ML, Mestman MD JH. Primary hyperparathroidism during pregnancy. Endocr Pract 1996; 2(5):362-7.
12. Clark OH, Duh Q-Y. Primary hyperparathyroidism. A surgical perspective. Endocrinol Metab Clin North Am 1989;18:701-14.
13. Norman J, Chedda H. Minimally invasive parathyroidectomy facilitated by intraoperative nuclear mapping. Surgery 1997;122:998.
14. Miccoli P, Bendinelli Ci Vignali E, et al. Endoscopic parathyroidectomy. Report of an initial experience. Surgery 1998;124:1077-80.
15. Feng PhD S, Moore Jr FD. Parathyroid reoperation with use of technetium 99m sestamibi radiolocalization and an intraoperative gamma counter. Endocr Pract 1996;2(6):382-4.
16. Procopio M, Magro G, Cesario F, Piovesan A, Pia A, Molineri N, Boretta G. The oral glucose tolerance test reveals a high frequency of both impaired glucose tolerance and undiagnosed Type 2 diabetes mellitus in primary hyperparathyroidism. Diabet Med 2002;19(11):958-61.
17. Bahl VK, Sandhu A, Mohan V, Nolan S. Multipl endocrine neoplasia and polyglandular autoimmune syndrome: a new association. Endocr Pract 1998;4(4):208-212.
18. Gertner ME, Kebebew E. Multipl endocrine neoplasia type 2. Curr Treat Options Oncol 2004;5(4):315-25.
19. Hales KF, Rosenberg RJ, Spencer RP. Coexistent parathyroid adenomas and Hurthle cell tumors: failure of full detection by substraction method. Clin Nucl Med 1998; 23(4): 205-7.
20. Ruf J, Lopez Hanninen E, Steinmuller T, Rohlfing T, Bertram H, Gutberlet M, Lemke AJ, Felix R, Amthauer H. Preeoperative localization of parathyroid glands. Use of MRI, scintigraphy, and image fusion. Nuklearmedizin 2004; 43(3): 85-90.
21. Otto D, Boerner AR, Hofmann M, Brunkhorst T, Meyer GJ, Petrich T, Scheumann GF, Knapp WH. Pre-operative localization of hyperfunctional parathyroid tissue with C-methionine PET. Eur J Nucl Med Mol Imaging 2004; 31:1405-12.
22. Kakuta T, Suzuki Y, Taolak F, Vemura K, Tanaka R, Tanaka S, Kuboto M, Sakai H, Kurokawa K, Saito A. Prognosis of parathyroid function after minimally invasive radioguided parathyroidectomy (MIRP) and percutaneous ethanol injection therapy for primary hyperparathyroidism. Biomed Pharmacother 2002;56 Suppl 1:41-47.
23. Lane MJ, Desser TS, Weigel RJ, Jeffrey RB. Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas. AJR Am J Roentgenol 1998;171(3):819-23.
24. Marcocci C, Mazzeo S, Bruno-Bossio G, Picone A. Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates. Euro J Endocrinol 1998;139(1):72-7.
25. Meekin GK. Intraoperative use of methylene blue localizes parathyroid adenoma. Laryngoscope 1998; 108(5): 772-3.
26. Yeung GH, Ng JW. The technique of endoscopic exploration for parathyroid adenoma of the neck. Aust N Z J Surg 1998;68(2)147-50.
27. Shiguro K, Ohgi S. Minimally invasive parathyroidectomy under local anesthesia. Biomed Pharmacother 2002;56 Suppl 1:31-33.
28. Henry JF, Sebag F, Misso C, Da Costa V, Tardivet L. New surgical approaches to primary hyperparathyroidism. Rev Med Suisse Romande 2004;124(2):93-5.