Surgical management of parathyroid disease

Primary hyperparathyroidism is a common endocrine disorder caused by excessive PTH production by one or more parathyroid glands. The diagnosis is via biochemistry and surgery is the definitive treatment. All patients with symptomatic disease or evidence of end-organ damage should be offered surgery if possible. Imaging studies are used to plan surgical strategy. The majority of patients with primary hyperparathyroidism have a single parathyroid adenoma. Positive imaging studies allow patients to undergo minimally invasive surgery. Negative imaging does not rule out surgery and patients should be offered a traditional bilateral neck exploration. Secondary hyperparathyroidism is most commonly caused by renal failure. Medical management is the first line treatment, followed by parathyroidectomy in selected cases. Tertiary hyperparathyroidism is seen in patients with continued autonomous function of the parathyroid glands after removal of the underlying stimulus. It is commonly seen in renal transplant patients and parathyroidectomy has a role.