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Article
July 1992

Continuing Evolution in the Operative Management of Primary Hyperparathyroidism

Author Affiliations

From the Department of Surgery and Radiology, The University of Chicago (Ill) Pritzker School of Medicine. Dr Fedorak is now with Loyola University Medical Center, Maywood, Ill.

Arch Surg. 1992;127(7):831-837. doi:10.1001/archsurg.1992.01420070095018
Abstract

• During the past several decades the operation for primary hyperparathyroidism at The University of Chicago, Ill, has changed from subtotal parathyroidectomy for all patients to removal of an adenoma with performance of biopsies of all other glands to bilateral neck exploration, resection of the adenoma, and performance of fewer biopsies of normal glands. During the 1980s, 308 operations were performed; 288 patients underwent first operations. Two hundred forty-five (85.1%) of these patients had an adenoma and forty-three (14.9%) had hyperplasia (multiglandular disease); none had a carcinoma. Resolution of hypercalcemia was achieved in 281 patients (97.5%); seven patients experienced failed explorations. The early cure was the same whether or not preoperative localization studies were performed. Nineteen patients underwent 20 reoperative parathyroidectomies during this period. Preoperative localization studies, done in 16 (80%) of 20 cases, were very helpful. Ninety percent of patients with abnormal parathyroid glands in their neck or mediastinum were cured with their initial reoperation.

(Arch Surg. 1992;127:831-837)

References
1.
Mandi F.  Therapeutischer Versuch bei Ostitis fibrosa generalisata mittels Exstirpation eines Epithelkorperchentumors . Wien Klin Wochenschr . 1925;50:1343-1344.
2.
Bauer W, Federman DD.  Hyperparathyroidism epitomized: case of Captain Charles E . Martell. Metabolism . 1962;11:21-29.
3.
Thompson NW.  The history of hyperparathyroidism . Acta Chir Scand . 1990;156:5-21.
4.
Paloyan ED, Pickleman JR.  Hyperparathyroidism today . Surg Clin North Am . 1973;53:211-220.
5.
Kaplan EL, Bartlett S, Sugimoto J, Fredland A.  Relation of postoperative hypocalcemia to operative technique: deleterious effect of excessive use of parathyroid biopsy . Surgery . 1982;92:827-834.
6.
Krubsack AJ, Wilson SD, Lawson TL, et al.  Prospective comparison of radionuclide, computed tomographic, sonographic, and magnetic resonance localization of parathyroid tumors . Surgery . 1989;106:639-646.
7.
Clark OH, Duh QY.  Primary hyperparathyroidism, a surgical perspective . Endocrinol Metab Clin North Am . 1989;18:701-714.
8.
Udekwu AO, Kaplan EL, Wu TC, Arganini M.  Ectopic parathyroid adenoma of the lateral triangle of the neck: report of two cases . Surgery . 1987;101:114-118.
9.
Wells SA Jr, Ellis GJ, Gunnels JC.  Parathyroid autotransplantation in primary parathyroid hyperplasia . N Engl J Med . 1976;295:57-62.Article
10.
Thompson N, Frederick E, Harness J.  The anatomy of hyperparathyroidism . Surgery . 1982;92:814-821.
11.
Hellman P, Skogseid B, Juhlin C, Akerstrom G, Rastad J.  Findings and long-term results of parathyroid surgery in multiple endocrine neoplasia type 1 . World J Surg . 1992;16:718-723.Article
12.
Kaplan EL, Yashiro T, Salti G.  Primary hyperparathyroidism in the 1990s: choice of surgical procedures for this disease . Ann Surg . 1992;215:300-317.Article
13.
Verdonk CA, Edis AJ.  Parathyroid 'double adenomas': fact or fiction? Surgery . 1981;90:523-526.
14.
Brothers TE, Thompson NW.  Surgical treatment of primary hyperparathyroidism in early patients . Acta Chir Scand . 1987;153:175-178.
15.
Wang C-A. In: Lucas RJ, Welsh RJ, Glover JL.  Unilateral neck exploration for primary hyperparathyroidism . Arch Surg . 1990;125:982-985. Invited commentary.Article
16.
Duh Q-Y, Uden P, Clark OH.  Unilateral neck exploration for primary hyperparathyroidism: analysis of a controversy using a mathematical model . World J Surg . 1992;16:654-662.Article
17.
Arganini M, Nirgiotis J, Fedorak I, Yashiro T, Fulton N, Kaplan EL.  The relationship between thyroid hormone status and serum calcium homeostasis after thyroid and parathyroid operations . Curr Surg . 1991;48:451-454.
18.
Wells SA Jr, Gunnells CJ, Gutman RA, Shelburne JD, Schneider AB, Sherwood LM.  The successful transplantation of frozen tissue in man . Surgery . 1977;81:86-90.
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