Diagnostic strategies and surgical procedures in persistent or recurrent primary hyperparathyroidism

The incidence of persistent or recurrent primary hyperparathyroidism reported in the literature lies between 1 and 10%. The main causes are represented by atypical locations or incorrect diagnosis of primary parathyroid hyperplasia. Since primary parathyroidectomy by an experienced surgeon has a success rate of 95%, there is no need for extended imaging studies prior to initial bilateral exploration. After confirming diagnosis of persistent or recurrent hyperparathyroidism exact localization studies are necessary. The most important procedures are ultrasonography, magnetic resonance imaging, technetium Tc99m sestamibi scintigraphy with a combined sensitivity of approximately 90%. In case of negative imaging results selective venous catheterization before reoperation can be performed. Reoperation by an experienced surgeon will be successful in 95% of cases.