Nouveautés thérapeutiques dans l'hyperparathyroïdie primitive

Modern imaging techniques such as ultrasonography and sestamibi scintigraphy (alone or combined with computed-tomography scanning) are useful for the preoperative localisation of a single adenoma in most cases. In such patients, minimally invasive parathyroidectomy may be considered, either by unilateral approach and local anaesthesia or by a video-assisted procedure. The success rate, assessed by perioperative rapid PTH assays, is of 84-90%, reaching 97% after conversion to conventional parathyroidectomy. Thoracoscopic resection may be considered for mediastinal adenomas. Specialized surgical teams have developed hypnotic approaches, locoregional anaesthesia or ultrasound-guided percutaneous ethanol injection. Medical treatment should soon include those calcimimetic drugs that are currently under evaluation. Anti-PTH immunization has shown efficacy in managing the rare cases of parathyroid cancer.